X線像による5年間の遡及的検討が行われた動脈瘤型原発性小腸悪性リンパ腫の1例

Aneurysmal Type Lymphoma of the Jejunum, Report of a Case with Reference to Roentgenologic Findings for Five Years

要旨　X線学的に5年間のさかのぼ及的検討ができた原発性空腸悪性リンパ腫の1例を経験し，その初期像，また発育進展に関して若干の知見を得たので報告した．腫瘍は腸管壁内に限局し，内腔に潰瘍や腫瘤を形成することもなく，全周性にびまん性の浸潤を呈し，腸管は著明な壁の肥厚と紡錘状拡張を来していた．組織学的には，non-Hodgkin lymphoma，diffuse，small cell type，well differentiated，B cell typeであった．さかのぼ及的検討から，本症例においては，腫瘍は腸管の長軸方向にびまん性に発育・進展し，腸管の紡錘状拡張を生じたものと考えられた．また小腸悪性リンパ腫のX線の初期像の1つとして，①病巣辺縁部の2～3mm大の顆粒の集簇，②区域性に認められるKerckringひだのわずかな腫大が重要な所見と考えられた．

　We report a case of primary malignant lymphoma of the jejunum, in which retrospective study was possible on roentgenological findings for 5 years. Preoperative radiological examination showed marked dilatation as well as thickened and flattened mucosal folds of the tumor (Figs. 3-5). Histological findings were consistent with malignant lymphoma (non-Hodgkin lymphoma, diffuse, small cell type, well differentiated, B-cell type) (Fig. 10).

　Retrospective analysis suggested that the following two findings were early findings of malignant lymphoma (Figs. 2-5): 1) Gathering small nodular polypoid lesions, partly consistent with submucosal component, in the mucosal folds and 2) segmental thickening or flattening of the mucosal folds.

　The growth pattern of aneurysmal type jejunal lymphoma in this case was considered as follows: the tumor took infiltrative form instead of polypoid or excavated form, thus causing diffuse wall thickening and aneurysmal dilatation of the small intestine.