炎症性疾患との鑑別を要した小腸原発性悪性リンパ腫の1例

Primary Malignant Lymphoma of the Small Intestine Resembling Inflammatory Diseases, Report of a Case

要旨　患者は55歳，男性．主訴は繰り返す下血と腹痛．小腸X線検査で空腸に単発性の狭窄像を認めた．狭窄部の中央には腸管の短軸方向に伸びる潰瘍と変形がみられ，その周囲には粗大な顆粒像が平板状に拡がっていた．個々の顆粒像の立ち上がりはなだらかで，表面は平滑であり，粘膜下腫瘍様の所見を呈していた．肉眼所見および術後X線所見でも潰瘍とその周囲に拡がる顆粒像が確認され，組織学的検索で病変部に一致して悪性リンパ腫の像が認められた．本症例は腸管の横軸方向に伸びる潰瘍のX線所見のため，小腸の潰瘍形成を示す炎症性疾患，特に腸結核との鑑別が必要であったが，潰瘍周囲にみられた粗大顆粒像が粘膜下腫瘍様所見を示すことから，術前に悪性リンパ腫の診断を得ることが可能であった．

　A 55-year-old male complained of repetitive hematochezia and abdominal pain. Small intestinal x-ray revealed a solitary stenotic lesion in the jejunum. In the center of this stenotic lesion existed an ulceration and deformity extending along the short axis of the bowel. The lesion was surrounded by coarse granulation, the border of which was smooth. These findings were suggestive of submucosal tumor.

　Examination of the surgically resected specimen confirmed these findings both macroscopically and radiographically. Furthermore, histological findings were consistent with malignant lymphoma.

　This case was unique in that an elongated ulcer along the short axis of the jejunum made it mandatory to take into consideration of inflammatory bowel diseases, especially intestinal tuberculosis. Coarse granulation around the ulcer, suggestive of submucosal tumor, was a clue to lead us to the preoperative diagnosis of malignant lymphoma.