初発から5年後,第2寛解期に骨顆粒球肉腫(M7)として再々発した高齢者急性骨髄性白血病(M0) Acute myelocytic leukemia (M0) in an elderly patient with relapsed granulocytic sarcoma (M7) of bone during the second period of complete remission 5 years after onset

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著者

    • 宮田 明 MIYATA Akira
    • 公立学校共済組合中国中央病院内科 Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers
    • 藤井 総一郎 FUJII Soichirou
    • 公立学校共済組合中国中央病院内科 Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers
    • 菊地 武志 [他] KIKUCHI Takeshi
    • 公立学校共済組合中国中央病院内科 Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers
    • 木畑 正義 KIBATA Masayoshi
    • 公立学校共済組合中国中央病院内科 Department of Internal Medicine, Chugoku Central Hospital of the Mutual Aid Association of Public School Teachers

抄録

症例は75歳, 男性. 平成6年急性骨髄性白血病 (AML: M0) として発症, 完全寛解に至るも, 平成8年に再発, 再寛解に至り, 平成10年3月をもって, 化学療法を終了していた. 平成11年10月右膝痛が出現し整形外科を経て当科に入院となった. 入院時右膝関節の軽度腫脹を認め, 入院時検査成績では末梢血には著変を認めず, 骨髄にもAML細胞を認めなかった. X線上右脛骨近位端に骨融解像を認め, 骨シンチでは右膝, 左大腿骨に集積を, MRIのT1強調画像で, 腫瘍部に一致して低信号域を認めた. 右脛骨生検組織は中から大型の核を有する細胞のびまん性増殖を認め, 免疫組織染色にてMPO, 非特異エステラーゼ, lysozyme, cytokeratin7, 9, 20, EMA, CEA, CD3, CD79a陰性, CD43, CD56陽性で, 生検組織の flow cytometry でCD7, CD13, CD33, CD41, CD56が強陽性であることより顆粒球肉腫 (granulocytic sarcoma, 以下GS), AML: M7と診断した. 放射線の局所照射 (36Gy) により右脛骨と左大腿骨の疹痛は軽減した. 本症例は初発時, 再発時ともCD7陽性のAML: M0であり, 初診時CD56は検索し得ていないが, CD7, CD56陽性の myeloid/NK cell precursor acute leukemia がM7に表面形質が変化した可能性も考えられた. しかし, M7に移行時にCD56を獲得しGSを形成した可能性も否定できない. 本症例は高齢かつ予後不良とされるAML: M0またはM7であるにもかかわらず, 発病より6年余り生存し得たことは, 高齢者AMLの予後不良因子をあまり有しておらず, 標準的化学療法と長期の維持療法が可能であったためとも考えられ, 全身状態良好な高齢者AMLにおける強力化学療法の意義を示唆するとも考えられる.

A 75-year-old man was admitted because of right knee joint pain in December 1999. He had suffered from acute myelocytic leukemia (AML; M0) in November 1994 and achieved the first complete remission (CR) then. His AML relapsed in August 1996, but fortunately he achieved a second CR. Radiographical bone examination revealed osteolytic lesions in his right knee and bone scintigraphy showed uptake in the right knee and the middle part of the left femur. MRI also revealed a low attenuation signal in the left femur. He had no abnormal findings in peripheral blood or bone marrow. Histological examination of the biopsied bone tissue showed a diffuse proliferation of round cells with medium-sized or large nuclei. These cells were histochemstrically negative for myeloperoxidase and naphtol-ASD-chloroacetate esterase, and were also negative for lysozyme, cytokeratin 7, 9, 20, EMA, CEA, CD3, CD79a on immunohistochemistry, but were positive for CD43, CD56. In immunophenotypic analysis of these cells by flow cytometry, CD7, CD13, CD33, CD41, CD56 were revealed to be strongly positive. On the basis of these findings we diagnosed these tumors as granulocytic sarcomas (GS), extramedullary recurrence of AML M7. Although radiation (36Gy) to these tumors brought a temporary relief of the pain, he died of systemic relapse of AML in February 2001. When presented CD7+ AML M0 had been diagnosed, but GS cells were also positive for CD56 and CD41. Although CD56 had not been examined initially, he might have been had myeloid/NK cell precursor acute leukemia and CD41 might be acquired later in the course of the disease. It is known that AML M0, M7 and myeloid/NK cell precursor acute leukemia have poor prognoses, nevertheless he survived for 6 years. It may be that intensive and repeated chemotherapy for AML can obtain excellent outcome in the elderly cases in good systemic condition and with favourable prognostic factors.

収録刊行物

  • 日本老年医学会雑誌

    日本老年医学会雑誌 40(2), 176-181, 2003-03-25

    一般社団法人 日本老年医学会

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各種コード

  • NII論文ID(NAID)
    10010768311
  • NII書誌ID(NCID)
    AN00199010
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    03009173
  • NDL 記事登録ID
    6536382
  • NDL 雑誌分類
    ZS21(科学技術--医学--内科学)
  • NDL 請求記号
    Z19-25
  • データ提供元
    CJP書誌  NDL  J-STAGE 
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