multiple lymphomatous polyposis様の消化管浸潤を呈した成人T細胞白血病の1例

Adult T-cell Leukemia with Multiple Lymphomatous Polyposis of the Intestinal Tract, Report of a Case

要旨　患者は55歳，男性．難治性下痢と腹部膨満感の精査加療目的で入院．左鎖骨上窩リンパ節腫大と腹部USおよびCTで腹腔内リンパ節腫大と腹水を認めた．血液検査では白血球数8,400/mm³で分画には異常を認めなかった．血清抗HTLV-1抗体陽性でLDHは高値であった．消化管X線検査では十二指腸から小腸および大腸にかけてポリープ様隆起が多発してみられた．十二指腸の隆起性病変の生検組織で非Hodgkin悪性リンパ腫（T細胞型）と診断された．以上から消化管浸潤を伴った成人T細胞白血病と診断し，化学療法を施行した．リンパ節腫大，ポリープ様隆起および腹水は消失し，症状も改善した．本例はmultiple lymphomatous polyposis様の消化管浸潤を呈した成人T細胞白血病の1例と考えられた．本例を含め成人T細胞白血病の消化管病変の特徴につき文献的考察を加え報告した．

　A 55-year-old man was admitted to our hospital complaining of refractory diarrhea and abdominal distension.

　The patient had swollen left supraclavicular and intraabdominal lymph nodes. He also had ascites.

　Hemogram on admission showed that white blood cell count was 8,400/mm³ with no abnormal lymphocytes. Serum LDH was elevated and anti-HTLV-1 antibody positive.

　Radiographic examinations revealed diffuse multiple polypoid lesions in the small and large intestines.

　Histological examination of the biopsied specimens from the duodenal polypoid lesions showed a diffuse infiltration of abnormal lymphocytes with irregular-shaped nuclei into the lamina propria mucosae and submucosae. Furthermore, infiltrating lymphocytes proved to be T cell phenotype by immunohistochemical examination.

　We thereby diagnosed the patient as having ATL with intestinal involvement.

　After the treatment with anti-cancer agents, his lymphadenopathy and ascites disappeared as well as improvement in diarrhea and abdominal distension. Disappearance of multiple polypoid lesions in the intestinal tract was confirmed by radiographic and endoscopic examinations.

　Intestinal lesions in this case were thought to be caused by infiltration of tumor cells, and resembled MLP.

　Further discussion was made on clinical and pathological features of the gastrointestinal lesions in patients with ATL.