臨牀消化器内科 Vol.26 No.12(5-2)


特集名 内視鏡で遭遇する大腸隆起型および表面型病変を見直す
題名 粘膜下腫瘍(SMT) (2) リンパ増殖性疾患(悪性リンパ腫)
発刊年月 2011年 11月
著者 中村 昌太郎 九州大学大学院病態機能内科学
著者 松本 主之 九州大学大学院病態機能内科学
【 要旨 】 隆起型を示す大腸悪性リンパ腫の内視鏡診断および治療について概説した.大腸リンパ腫の40〜50%は隆起型ないしMLP(multiple lymphomatous polyposis)型を呈する.隆起型は,組織学的にMALTリンパ腫がもっとも多いが,びまん性大細胞型B細胞リンパ腫やその他の組織型も隆起型を呈することがある.しばしば潰瘍を形成し,癌,GIST(gastrointestinal stromal tumor)やカルチノイド腫瘍などとの鑑別が重要である.治療法はwatch & wait,外科的切除,化学療法,放射線療法,抗菌薬療法など多岐にわたり,組織型と臨床病期に応じて決定する.
Theme Reappraisal of Colorectal Protruded and Flat Lesions Which are Encountered During Endoscopy
Title Colorectal Lymphoma of the Polypoid Form
Author Shotaro Nakamura Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
Author Takayuki Matsumoto Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University
[ Summary ] The endoscopic diagnosis and treatments for colorectal lymphomas of the polypoid form are described. Macroscopically, 40-50 % of colorectal lymphomas present in the polypoid form. The most frequent histologic type of polypoid lymphoma is MALT lymphoma, followed by diffuse large B-cell lymphoma (DLBCL), and other types, including follicular lymphoma or T-cell lymphoma. It is important to endoscopically distinguish these polypoid lymphomas from other neoplastic lesions, such as carcinoma, gastrointestinal stromal tumor (GIST), or carcinoid tumors. There are various treatment modalities for colorectal lymphomas, such as, surgery, chemotherapy, radiotherapy, antibiotic treatment, rituximab immunotherapy or€watch and wait strategy. The particular treatment strategy should be carefully determined based on the histologic type of lymphoma and the clinical stage of the disease.
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