末梢神経・筋のリンパ腫

Lymphoma in the Peripheral Nerves and Muscles

非ホジキンリンパ腫は，腫瘤から隣接した神経・筋組織に浸潤が及ぶこともあるが，末梢神経や筋から初発や再発しうる。神経や筋の組織学的構造に沿って浸潤する。浸潤は神経根からは中枢神経に及ばないことが多く，組織親和性が想定される。初期には血清可溶性IL-2やMRI，FDG-PETでも診断困難なことや，髄膜播種を伴っても髄液では診断できないことがある。骨髄などの他臓器の検索が有用なことがある。他の腫瘍のほか，慢性炎症性脱髄性多発根ニューロパチーや局所性筋炎との鑑別が問題になることがある。

Abstract

Non-Hodgkin lymphoma occurs and recurs in the peripheral nerves or skeletal muscles. Lymphoma cells infiltrate along anatomic structures. They typically do not invade the central nervous system from the cranial or peripheral nerve roots. Analysis of cerebrospinal fluid often does not lead to the diagnosis of neurolymphomatosis, even when meningeal infiltration is present. The concentration of soluble interleukin 2 (IL2) receptor, together with the findings of magnetic resonance imaging (MRI) and 18 fluoro-2-deoxyglucose positron emission tomography (FDG-PET) may contribute to the diagnosis, but not in early stages of the disease. Investigation of other tissues including bone marrow is sometimes useful. Differential diagnosis includes inflammatory demyelinating neuropathy in the nerve, and focal myositis in the muscle, in addition to other malignancies. Some lymphoma clones appear to have affinity for the peripheral nerves or muscle tissues