Yamaguchi Tetsuya, Takahashi Hiroshi, Kagawa Ryuzaburou, Takeda Ryoji, Sakata Shingo, Nishizaki Daisuke, Takamatsu Teruyuki, Iwasa Yoko
Department of Surgery, Rakuwakai-Otowa Hospital, Yamashina-ku, Kyoto 607-8062, Japan.
Hepatogastroenterology. 2008 May-Jun;55(84):891-4.
Herein is described a mesenteric diffuse large B cell lymphoma (DLBCL) case with a bulky mass which had achieved a complete remission by the combination therapy of a surgical resection and the CHOP chemotherapy with rituximab. A 78 year old man was referred to the Rakuwakai-Otowa Hospital due to a left lower abdominal tumor. Abdominal CT and MRI showed a bowel-like mass in the left lower abdominal cavity. Abdominal US revealed lymph node swellings at the paraaortic region. By the gastro-duodenoscopy, DLBCL of non-Hodgkin's lymphoma was proven at the 2nd portion of the duodenum. On laparotomy, a mass of 8x8cm in size was found at the mesenterium of the ileum, which directly invaded the ileum and the sigmoid mesocolon. A partial resection of the ileum and the sigmoid colon was performed. After the operation, it was determined to be Stage IV DLBCL and the chemotherapy based on the R-CHOP regimen was performed. The regimen was repeated to the 6th course. During the chemotherapy, he was confirmed to have achieved a complete remission. The present case is a rare case in which a Stage IV mesenteric DLBCL with extensive bulky masses had a favorable prognosis. Stage IV mesenteric DLBCLs with extensive bulky masses are thought to be the indication for the combination therapy of surgical resection and multiagent chemotherapy with rituximab.
本文描述了一例肠系膜弥漫性大B细胞淋巴瘤（DLBCL）病例，该病例有巨大肿块，通过手术切除联合含利妥昔单抗的CHOP化疗实现了完全缓解。一名78岁男性因左下腹肿瘤被转诊至乐和会音羽医院。腹部CT和MRI显示左下腹有肠样肿块。腹部超声显示腹主动脉旁区域淋巴结肿大。通过胃十二指肠镜检查，在十二指肠第二部证实为非霍奇金淋巴瘤的DLBCL。剖腹手术时，在回肠系膜发现一个大小为8×8cm的肿块，该肿块直接侵犯回肠和乙状结肠系膜。对回肠和乙状结肠进行了部分切除。术后，确定为IV期DLBCL，并进行了基于R-CHOP方案的化疗。该方案重复至第6疗程。化疗期间，确认其已实现完全缓解。本病例是罕见的IV期肠系膜DLBCL伴广泛巨大肿块且预后良好的病例。IV期肠系膜DLBCL伴广泛巨大肿块被认为是手术切除联合含利妥昔单抗的多药化疗的适应证。
