Tamura Hideto, Ogata Kiyoyuki, Kondo Asaka, Wakita Tomoya, Inami Mitsuharu, Mizuki Taro, Hyodo Hideya, Shioi Yumiko, Nakamura Kyoko, Mitsui Keigo, Tanaka Shu, Sakamoto Choitsu, Dan Kazuo
Division of Hematology, Department of Medicine, Nippon Medical School.
Rinsho Ketsueki. 2007 Jun;48(6):510-3.
Primary small intestinal lymphoma (PSIL) is a relatively rare form of non-Hodgkin lymphoma, often complicated by bleeding, obstruction, or perforation of the intestine during the clinical course. The initial diagnosis and management of these complications are often difficult in PSIL, because the small intestine is usually inaccessible in routine endoscopy. Recently, total enteroscopy with a double-balloon method, called double balloon endoscopy (DBE), has been developed for the diagnosis and treatment of small intestinal disorders. We report herein on 4 cases of PSIL (2 diffuse large B-cell lymphomas and 2 follicular lymphomas [FLs]). In these cases, DBE was useful in the diagnosis, decision to perform surgery after assessment of bleeding lesion, and treatment of the intestinal stenosis using enteroscopic balloon dilatation. Combination chemotherapy consisting of anthracycline, cyclophosphamide, vincristine, and prednisolone with rituximab was administered in 3 cases, and all achieved complete remission. One patient with FL of the duodenum was treated with rituximab alone, but with little effect. We conclude that DBE is useful in the management of PSIL. More PSIL cases must be analyzed to establish the optimal management of patients with this form of lymphoma.
原发性小肠淋巴瘤（PSIL）是一种相对罕见的非霍奇金淋巴瘤，在临床过程中常并发肠道出血、梗阻或穿孔。在PSIL中，这些并发症的初始诊断和处理通常很困难，因为在常规内镜检查中，小肠通常难以触及。最近，一种称为双气囊内镜检查（DBE）的双气囊法全小肠镜已被开发用于小肠疾病的诊断和治疗。我们在此报告4例PSIL（2例弥漫性大B细胞淋巴瘤和2例滤泡性淋巴瘤[FLs]）。在这些病例中，DBE在诊断、评估出血病变后决定是否进行手术以及使用内镜球囊扩张治疗肠道狭窄方面均有用。3例患者接受了由蒽环类药物、环磷酰胺、长春新碱和泼尼松龙联合利妥昔单抗组成的联合化疗，均实现完全缓解。1例十二指肠FL患者仅接受利妥昔单抗治疗，但效果不佳。我们得出结论，DBE在PSIL的管理中有用。必须分析更多PSIL病例，以确立这种淋巴瘤患者的最佳管理方案。
