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悪性リンパ腫における治療方針の選択

出典
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1: 著者提供

悪性リンパ腫の小腸造影像(非狭窄型)

回腸末端に潰瘍を伴う腫瘤陰影(矢印)が確認できる。病変は広範囲にわたるものの、比較的拡張性が保たれており、腸閉塞の所見はない。
出典
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1: Adam, Andreas, et al.: Grainger & Allison's Diagnostic Radiology, 6th ed., Elsevier, 2015. Figure28-27. [https://www.clinicalkey.jp/#!/content/book/3-s2.0-B9780702042959000289]

大腸悪性リンパ腫のCT像

軽度造影効果を有した全周性の壁肥厚を認める(矢印)。腸管内腔が保たれており、閉塞は伴っていない。
出典
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1: Adam, Andreas, et al.: Grainger & Allison's Diagnostic Radiology, 6th ed.,Elsevier,2015. Figure29-22. [https://www.clinicalkey.jp/#!/content/book/3-s2.0-B9780702042959000290?scrollTo=%23f0115]

悪性リンパ腫の小腸造影像(動脈瘤型)

回腸の腸管内腔が動脈瘤様に拡張・変形し(矢印)、病変部ではケルクリング皺襞が認められない。
出典
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1: Imaging of gastrointestinal lymphoma.
著者: Marc J Gollub
雑誌名: Radiol Clin North Am. 2008 Mar;46(2):287-312, ix. doi: 10.1016/j.rcl.2008.03.002.
Abstract/Text: The gastrointestinal (GI) tract contains the largest collection of lymphocytes anywhere in the body. GI lymphoma may arise at any site in the GI tract but typically involves the stomach and small bowel in cases of systemic disease. Most cases are non-Hodgkin B-cell type. Enteropathy-associated T cell lymphoma can complicate celiac disease. Less commonly, lymphoma may originate in the GI tract without systemic involvement. This sometimes occurs in response to chronic infections. This article discusses the role of imaging in detecting and staging GI tract lymphomas, using fluoroscopy and cross-sectional imaging, primarily CT.
Radiol Clin North Am. 2008 Mar;46(2):287-312, ix. doi: 10.1016/j.rcl.2...

回盲部悪性リンパ腫による腸重積(注腸造影およびCT画像)

a:上行結腸内がカニ爪様に造影されており、上行結腸中央部まで先進する腸重積と考えられる。
b:CTでは、右側横行結腸内に嵌入する小腸(矢印左)と、左側横行結腸内に浮腫状で同心円状の層構造を持つ腫瘤が確認でき(矢印右)、横行結腸にまで先進する腸重積と考えられる。
出典
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1: Imaging of gastrointestinal lymphoma.
著者: Marc J Gollub
雑誌名: Radiol Clin North Am. 2008 Mar;46(2):287-312, ix. doi: 10.1016/j.rcl.2008.03.002.
Abstract/Text: The gastrointestinal (GI) tract contains the largest collection of lymphocytes anywhere in the body. GI lymphoma may arise at any site in the GI tract but typically involves the stomach and small bowel in cases of systemic disease. Most cases are non-Hodgkin B-cell type. Enteropathy-associated T cell lymphoma can complicate celiac disease. Less commonly, lymphoma may originate in the GI tract without systemic involvement. This sometimes occurs in response to chronic infections. This article discusses the role of imaging in detecting and staging GI tract lymphomas, using fluoroscopy and cross-sectional imaging, primarily CT.
Radiol Clin North Am. 2008 Mar;46(2):287-312, ix. doi: 10.1016/j.rcl.2...

多発性ポリポーシス型の肉眼所見および病理所見

肉眼的に盲腸内に小型隆起性病変が集簇する所見を認める(a)。組織学的にはこれらの隆起は粘膜から粘膜下層に広がる悪性リンパ腫の像(矢印)を示し、非連続性の進展を多数認めた(b)。
出典
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1: Feldman:Sleisenger and Fordtran's Gastrointestinal and Liver Disease, 10th ed.Fig31-5.Copyright © 2016 Saunders, An Imprint of Elsevier.

小腸内視鏡検査による悪性リンパ腫の検索

小腸内視鏡検査による検索で空腸全域にわたりポリポーシス様の病変を認めた(a、c)。一部に易出血性の隆起性病変(矢印)を認めた(b)。生検により濾胞性リンパ腫の診断が得られた。
出典
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1: Lymphomatous polyposis of the small intestine.
Gastrointest Endosc. 2008 Apr;67(4):763-5. doi: 10.1016/j.gie.2007.09.035. Epub 2008 Jan 22.

臨床病期分類(Lugano国際分類)

出典
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1: Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma.
著者: A Rohatiner, F d'Amore, B Coiffier, D Crowther, M Gospodarowicz, P Isaacson, T A Lister, A Norton, P Salem, M Shipp
雑誌名: Ann Oncol. 1994 May;5(5):397-400.
Abstract/Text: It was considered timely to review the pathological and staging classifications of GI tract lymphoma. This meeting specifically did not address the question of treatment; the management of GI tract lymphoma could perhaps form the basis for a further workshop. The following recommendations were made: to adopt the Isaacson histological classification, that all patients with GI tract lymphoma be investigated uniformly, to record the prognostic factors described above, to use the staging classification shown above. It is hoped that these recommendations will be taken into account in the design of future clinical trials of therapy for GI tract lymphoma.
Ann Oncol. 1994 May;5(5):397-400.

改訂Ann Arbor 分類

ホジキンおよび非ホジキンリンパ腫の臨床病期(Ann Arbor分類)
出典
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1: Staging and classification of lymphoma.
著者: Ping Lu
雑誌名: Semin Nucl Med. 2005 Jul;35(3):160-4. doi: 10.1053/j.semnuclmed.2005.02.002.
Abstract/Text: In 2004, new cases of non-Hodgkin's lymphoma in the United States were estimated at 54,370, representing 4% of all cancers and resulting 4% of all cancer deaths, and new cases of Hodgkin's lymphoma were estimated at 7,880. The appropriate staging and management of lymphomas greatly depend on an accurate pathological diagnosis and classification. The recently established Revised European-American Classification of Lymphoid Neoplasms (REAL) and the subsequently adopted and updated World Health Organization (WHO) classification include modern cytogenetic, molecular, and immunologic techniques and knowledge and reach an international consensus on the classification of lymphomas. This classification scheme represents an advance in our understanding of lymphomas and serves as an operative guideline for studying and diagnosing lymphomas. Imaging techniques always have served as staging and monitoring tools for the clinical management of lymphomas. The understanding and adoption of the current classification system is important in refining the role of imaging modalities in the management of specific lymphoma. To help one understand the current classification, this current review gives a brief history of lymphoma classifications and summaries the recent classification schemes, including new entities, clinical staging methods, and clinical prognostic criteria.
Semin Nucl Med. 2005 Jul;35(3):160-4. doi: 10.1053/j.semnuclmed.2005.0...

下部消化管内視鏡検査による悪性リンパ腫の検索

内視鏡所見は、潰瘍を伴う隆起性病変(a)、あるいはびまん性に浸潤する非狭窄病変(b)など、多彩である。
出典
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1: Clinicopathologic features of ileocolonic malignant lymphoma: analysis according to colonoscopic classification.
著者: Seung-Jae Myung, Kwang Ro Joo, Suk-Kyun Yang, Hwoon-Yong Jung, Hye-Sook Chang, Hyun Ju Lee, Weon-Seon Hong, Jin-Ho Kim, Young Il Min, Hee Cheol Kim, Chang Sik Yu, Jin Cheon Kim, Jung-Sun Kim
雑誌名: Gastrointest Endosc. 2003 Mar;57(3):343-7. doi: 10.1067/mge.2003.135.
Abstract/Text: BACKGROUND: The aims of this study were to classify primary ileocolonic lymphomas according to colonoscopic findings and to determine the clinicopathologic relationship according to classes.
METHODS: Thirty-two patients (22 men, 10 women; age range 29 to 75 years) with primary malignant lymphoma of the terminal ileum and/or colorectum were studied. The clinicopathologic features were evaluated according to colonoscopic findings.
RESULTS: Thirty-six lesions in 32 patients were endoscopically classified as follows: fungating (14, 39%), ulcerofungating (11, 31%), infiltrative (5, 14%), ulceroinfiltrative (4, 11%), and ulcerative (2, 6%). Location of the lesions was as follows: terminal ileum, 15 (42%); colorectum, 14 (39%); both regions, 7 (19%). The most common histopathologic types were diffuse large cell (22, 69%) and large cell immunoblastic (5, 16%). There was no relationship between the endoscopic findings and histologic types. In 9 patients (28%), the clinical manifestation was intussusception, and all were found endoscopically to have the fungating type lesion.
CONCLUSIONS: Primary ileocolonic lymphomas can be classified endoscopically into fungating, ulcerative, infiltrative, ulcerofungating, and ulceroinfiltrative types. Among these, fungating and ulcerofungating are the most frequent. Intussusception is a common clinical finding in ileocolonic lymphomas, occurring mainly in patients with the fungating type of lesion.
Gastrointest Endosc. 2003 Mar;57(3):343-7. doi: 10.1067/mge.2003.135.

回盲部における悪性リンパ腫像

回盲部の造影では回腸末端から盲腸にかけて襞の肥厚や潰瘍形成を示す腫瘤像(矢印)を認める(a)。CTにて同部位の壁の肥厚(矢印)を認める(b)。比較的広範囲に広がる病変で、腸管の拡張不良を呈する。軽度の通過障害を認めるが、明らかな腸閉塞は示さない。
出典
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1: Imaging of GastrointestinalLymphoma Marc J. Gollub Radiol Clin N Am 46 (2008) 287–312.Fig22.2008 Elsevier Inc.

悪性リンパ腫における治療方針の選択

出典
img
1: 著者提供

悪性リンパ腫の小腸造影像(非狭窄型)

回腸末端に潰瘍を伴う腫瘤陰影(矢印)が確認できる。病変は広範囲にわたるものの、比較的拡張性が保たれており、腸閉塞の所見はない。
出典
img
1: Adam, Andreas, et al.: Grainger & Allison's Diagnostic Radiology, 6th ed., Elsevier, 2015. Figure28-27. [https://www.clinicalkey.jp/#!/content/book/3-s2.0-B9780702042959000289]