Yamamoto K, Shiraishi T, Ajiki T, Imai Y, Oyanagi H, Saito Y
First Department of Surgery, Kobe University School of Medicine, Japan.
Gastroenterol Jpn. 1991 Oct;26(5):649-53. doi: 10.1007/BF02781683.
A case of intestinal cytotoxic/suppressor T-cell lymphoma with repeated episodes of perforation was seen in a 77-year-old Japanese male who was admitted complaining of severe abdominal pain accompanied by high grade fever. Surgery revealed diffuse peritonitis due to perforation in the sigmoid colon. After a loop sigmoid colostomy the patient recovered to some degree. Seven days later, however, another perforation occurred. Several aneurysmal swellings accompanied by perforation in the small intestine, forming a mass of 5 x 5 cm, were seen. Although the patient tolerated this operation, generalized emaciation proceeded and the patient died 10 days late. Histological examination at the second operation showed diffuse medium-sized lymphoma of the Lymphoma Study Group (LSG) classification infiltrating the entire depth of the intestinal wall. Destruction of muscle cells was prominent. An immunohistochemical study using fresh frozen material was positive for CD3, and CD8. This marked destruction of the muscle layer by lymphoma cells may be associated with repeated episodes of perforation.
一名77岁的日本男性因严重腹痛伴高热入院，被诊断为肠道细胞毒性/抑制性T细胞淋巴瘤，伴有反复穿孔发作。手术显示乙状结肠穿孔导致弥漫性腹膜炎。行乙状结肠袢式造口术后，患者有所恢复。然而，7天后又发生了一次穿孔。在小肠发现了几个伴有穿孔的动脉瘤样肿胀，形成了一个5×5厘米的肿块。尽管患者耐受了这次手术，但全身消瘦仍在继续，患者于10天后死亡。第二次手术的组织学检查显示，淋巴瘤研究组（LSG）分类的弥漫性中大小淋巴瘤浸润肠壁全层。肌肉细胞破坏明显。使用新鲜冷冻材料进行的免疫组织化学研究显示CD3和CD8呈阳性。淋巴瘤细胞对肌肉层的这种显著破坏可能与反复穿孔发作有关。
