全身性エリテマトーデスに合併した直腸原発悪性リンパ腫の1例 Malignant Lymphoma of the Rectum in a Patient with Systemic Lupus Erythematosus

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症例は71歳, 女性. 全身性エリテマトーデスにて加療中, 下血を認め精査施行. 上部直腸に易出血性の隆起性病変を認め, 生検組織にて炎症性直腸粘膜の診断であった. 腫瘍性病変の可能性もあり, 確定診断の目的にてリンパ節郭清をともなう直腸低位前方切除術を施行した. 切除された腫瘍は直径4.0cmで, 病理組織学的に異型リンパ球 (CD20陽性, CD5陰性) の浸潤増殖像から成り, low grade B-cell lymphoma, mucosal associated lymphoid tissue (MALT) typeであった. 所属リンパ節には腫瘍性変化は認めず, 臨床病期Iの直腸原発悪性リンパ腫と診断された.<br>自己免疫性疾患に悪性疾患, 特に悪性リンパ腫が合併した報告例は散見されるが, 消化管原発悪性リンパ腫が合併した例はまれである. 今回われわれは, 全身性エリテマトーデスに直腸原発悪性リンパ腫が合併した一例を経験したので文献的考察を含め報告する.

A 71-year-old woman with systemic lupus erythematosus complained of anal bleeding. Barium enema and colonoscopy revealed an elevated tumor above the peritoneal reflection of the rectum. A biopsy specimen showed no specific findings other than chronic inflammation. To establish a pathological diagnosis, a low-anterior resection with lymph node dissection was performed. The resected tumor measured 4.0 cm in maximal diameter. Microscopically, it was composed of diffuse proliferation of atypical lymphoid cells, which were positive for CD20, but negative for CD5, on immunohistochemical staining. The tumor was diagnosed as a B-type non-Hodgkin's lymphoma, with low-grade features : mucosal associated lymphoid tissue (MALT) type. The dissected lymph node showed no definite evidence of lymphoma cell infiltration, and this lesion was diagnosed as a clinical stage I rectal lymphoma.<br>Some patients with autoimmune disorders associated with hemopoietic organ-related cancer, especially malignant lymphoma, have been previously reported in the literature. However, patients with autoimmune disorders associated with primary colorectal lymphoma are rare. We report a case of primary rectal lymphoma in a patient with systemic lupus erythematosus, and discuss this rare case.

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  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 60(2), 95-99, 2007-02-10 

    The Japan Society of Coloproctology

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