multiple lymphomatous polyposis類似の消化管病変を認めた全身性悪性リンパ腫の1例

Systemic Malignant Lymphoma with Numerous Polyps in the Gastrointestinal Tract, Report of a Case

要旨　患者は59歳男性で上腹部不快感を主訴とし来院．全身の表在リンパ節腫脹と軽度の低蛋白血症を認めたが，白血球数・分画に異常はなかった．消化管X線および内視鏡検査で胃には1個の粘膜下腫瘍，小腸・大腸には微小な多発性ポリープ病変を認めた．リンパ節生検標本と各消化管病変の生検標本から異型リンパ球のびまん性浸潤増殖がみられ，非ホジキン悪性リンパ腫と診断した．VEPA療法で胃病変の著明な縮小および小腸・大腸のポリポーシスの消失を認めた．本例は形態学的にはMLPと考えられるが，従来報告されているMLPの中にも続発性のリンパ腫が含まれている．以上よりMLPの疾患概念の再検討が必要と考えられる．

　A 59-year-old man visited our hospital with epigastric discomfort as his chief complaint.

　His physical examination showed that peripheral lymph node was palpable, but hepatosplenomegaly was not noted.

　Peripheral blood picture was normal. The serum total protein was slightly less than normal.

　X-ray and endoscopic examinations revealed a submucosal tumor in the stomach and multiple small polypoid lesions in the small and large intestines.

　The biopsy specimens taken from the inguinal lymph node and gastrointestinal lesions revealed the tumor to be non-Hodgkin's malignant lymphoma.

　After chemotherapy, x-ray and endoscopic findings concerning the lesions were markedly improved. Also, the pathological findings from the biopsy specimens of the gastrointestinal lesions showed marked improvement.

　This case resembles MLP, though this patient had a systemic malignamt lymphoma.

　Thus, the problem, whether or not MLP should fe defined as being limited in its primary origin to the gastrointestinal tract, still remains unsolved.