multiple lymphomatous polyposis様の消化管病変を伴った全身性悪性リンパ腫の1例―その治癒過程の観察を含めて

Systemic Malignant Lymphoma with Multiple Lymphomatous Polyposis-like Gastrointestinal Involvement, Report of a Case

要旨　患者は67歳女性，主訴は新鮮血の下血．左右頸部と縦隔にリンパ節の軽度腫大を認めた．消化管X線・内視鏡検査で十二指腸から直腸にかけて中心陥凹を持つ小隆起性病変が多発し，特に十二指腸と回腸終末部，下部大腸に密生していた．直腸の隆起性病変を試験切除し，non Hodgkin's lymphoma，diffuse large cell type，B cellと診断した．化学療法により隆起性病変は徐々に縮小し黄白色の小顆粒状隆起となり，治療開始約3か月後には消失した．本症例は multiple lymphomatous polyposis (MLP) of the gastrointestinal tractの形態を呈した全身性悪性リンパ腫の1例と考えられ，その治癒過程から，MLPにおける完全緩解の画像診断の基準として興味深い症例であった．

　A 67-year-old female patient came to our hospital complaining of hematochezia. Physicial examination disclosed swollen cervical lymph nodes of 10 mm in diameter on both sides, but there was no hepatosplenomegaly. Gastrointestinal x-ray and endoscopic examinations revealed the presence of multiple polypoid lesions with central excavation from the duodenum to the rectum: the distribution of these lesions was dense particularly in the duodenum, terminal ileum and recto-sigmoid. Computed tomography of the mediastinum revealed the presence of swollen lymph nodes. Snare biopsy of a polypoid lesion in the rectum was performed leading to the histological diagnosis of non-Hodgkin's lymphoma, diffuse cell type, B-cell origin. Chemotherapy with LSG 4 protocol started, which was followed by diminution of the polypoid lesions; complete remission was confirmed three months later. Thus, this case was considered to be systemic malignant lymphoma with multiple lymphomatous polyposis-like gastrointestinal tract involvement.