抗human T-lymphotropic virus type-1 (HTLV-1)抗体陰性の胃原発T細胞リンパ腫の1例 A CASE OF PRIMARY GASTRIC T-CELL LYMPHOMA (PGTCL) WITHOUT ANTI-HUMAN T-LYMPHOTROPIC VIRUS TYPE-1 (HTLV-1) ANTIBODY

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稀有な抗 human T-lymphotropicvirustype-1(HTLV-1) 抗体陰性の原発性胃T細胞リンパ腫の1例を経験したので,本邦の17報告例とともに検討した.症例は67歳,男性.上腹部不快を訴え来院した.胃精査で胃体~前庭に2型の腫瘤を認め,生検で悪性リンパ腫と診断した.CTで局所リンパ節の腫大を認めた.抗HTLV-1抗体は陰性であった. 胃全摘, 脾摘, 肝部分切除, D 3 郭清を行てった. 組織学的にはびまん, 混合型,表面形質はCD20<SUP>-</SUP>,CD3<SUP>+</SUP>で,CD4<SUP>+</SUP>,CD8<SUP>-</SUP>のT細胞リンパ腫であった.術後6カ月および11カ月に頸部リンパ節に再発したがCHOPおよび次世代多剤併用化学療法でそれぞれ寛解して,術後22カ月生存中である.<BR>症例は報告例と対比すると,ほぼ平均的な臨床病理学的所見を示していた.報告群には病期IIE(Ann-Arbor),胃切除例が多いが,6,12,24カ月生存率はそれぞれ85.7,62.9,62.9%で,この病期では胃切除,術後化学療法が治療選択と思われた.本群の治療指針,予後判定因子などを明確にするために,さらに症例の集積が必要であろう.

This paper presents a case of primary gastric T-cell lymphoma with negative HTLV-1 antibody, together with a review of 17 cases in the Japanese literature. A 67-year-old man was admitted to the hospital because of upper abdominal distress. A large tumor resembling type 2 of gastric cancer was detected at the body of stomach by upper G-I series and endoscopy. The biopsy revealed malignant lymphoma. No other lesions were noted except regional lymph node swelling by CT-scan. Serology was negative for HTLV-1 antibody. A total gastrectomy with a splenectomy and a partial hepatic resection, and lymph node dissection were performed. Histology of the resected material revealed diffuse and mixed cell type of lymphoma. Surface markers for lymphocyte were CD20-/CD3+ and CD4+/CD8-, showing T-cell lymphoma. Nodal recurrences appeared in the cervical region six and 11 months after the surgery. The patient responded well to the CHOP, and then a second-line chemotherapy. He has been living well with a partial response for the postoperative 22 months.<BR>The present case showed almost similar clinicopathologic features to the reported cases. Six-,12and 24-months survival rates of these cases, consisted mainly of Stage IIEs (Ann-Arbor), were 82.5 62.9 and 62.9%, respectively. Therefore, gastrectomy followed by an appropriate chemotherapy was considered to be a treatment of choice for this Stage. Further accumulation of cases would be necessary for determining the treatment or the prognosis of this disease.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 62(2), 381-386, 2001-02-25

    日本臨床外科学会

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各種コード

  • NII論文ID(NAID)
    10008388049
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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