片側下肢痛にて発症した悪性リンパ腫再発（intravascular lymphomatosis）の1例

Recurrence of a Malignant Lymphoma Presenting with Leg Pain (Intravascular Lymphomatosis) : Case Report

　抄録：片側下肢痛にて発症し，慢性の経過を経て悪性リンパ腫（intravascular lymphomatosis：IVL）の診断に至った1症例を経験した．症例は74歳，女性．1993年に他院で咽頭部の悪性リンパ腫と診断され，放射線治療を受けた．その後1999年まで外来通院し，再発を疑う所見はなかった．1997年3月より左下肢痛出現．同年12月より原因不明の左下肢麻痺が出現し，2000年1月，当院に紹介入院となった．精査するも明らかな原因病巣みつからず，3月上旬転院．その後右下肢麻痺に続いて両上肢麻痺も出現し，3月28日再入院．MRIの異常および髄液検査にて上記診断に至った．IVLは多彩な病態を示すため，原因不明の脊髄・神経根症状においては本症を考慮する必要があると考えられた．

　Intravascular lymphomatosis (IVL) was diagnosed in the lumbosacral spinal cord of a 74-year-old woman with paresis and pain in her left leg. No symptoms or laboratory data indicated recurrence of a malignant lymphoma that had been treated with radiation four years before the onset of her present symptoms. Three years after the onset she developed paraparesis of her both legs. The MRI of the lumbosacral spinal cord showed abnormal enlargement of the cord and cauda equina, that had not been detected when she had complained of the paresis and pain in her right leg. And there was an increase in the atypical lymphocytes count in the CSF. Because of the appearance of the atypical lymphocytes in the CSF, the paraparesis of both legs was concluded to be secondaly to the IVL.

　Since IVL is manifested by a variety pathological features, it should be considered in patients with paresis of unknown origin.