Keicho N, Hagiwara K, Takeuchi K, Oka T, Yotsumoto H, Takaku F
Third Department of Internal Medicine, University of Tokyo, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1990 Nov;28(11):1516-22.
A 45 year-old male was admitted to Tokyo University Hospital because of a submandibular tumor. Biopsy specimen of the tumor showed medium-sized non-Hodgkin's lymphoma of follicular type and immunoperoxidase staining of frozen sections demonstrated an overwhelming predominance of B lymphocytes with IgM, lambda chain. In the meanwhile, chest X-ray taken on admission showed an ill-defined consolidation with a tumor-like appearance in the right middle lung field. Transbronchial biopsy of this lesion revealed massive infiltrations of small and medium sized lymphocytes, having the same markers as those of submandibular tumor (IgM, lambda chain) and an analysis of bronchoalveolar lavage showed a significant increase of CD19-positive B lymphocytes. Reviewing of check-up X-ray films showed the lung lesion to have preceded the submandibular tumor and to have increased its size in several years. On the basis of the similarity of histological and immunohistochemical findings between pulmonary and submandibular tumor, and considering the time course of the appearance of these tumors, we concluded that these tumors were of the same histological nature and had originated in the lung and metastasized to submandibular gland. This is a relatively rare case of pulmonary lymphoma metastasizing to the submandibular gland, in which transbronchial biopsy specimen and analysis of lymphocytes in bronchoalveolar lavage were helpful in establishing the diagnosis.
一名45岁男性因下颌下肿瘤入住东京大学医院。肿瘤活检标本显示为滤泡型中大小的非霍奇金淋巴瘤，冰冻切片免疫过氧化物酶染色显示以带有IgM、λ链的B淋巴细胞占绝对优势。与此同时，入院时胸部X线片显示右中肺野有边界不清的实变，呈肿瘤样外观。该病变经支气管活检显示有大量中小淋巴细胞浸润，其标记物与下颌下肿瘤相同（IgM、λ链），支气管肺泡灌洗分析显示CD19阳性B淋巴细胞显著增加。回顾体检X线片发现肺部病变先于下颌下肿瘤出现，且数年来其大小有所增大。基于肺部和下颌下肿瘤组织学及免疫组化结果的相似性，并考虑到这些肿瘤出现的时间进程，我们得出结论，这些肿瘤具有相同的组织学性质，起源于肺部并转移至下颌下腺。这是一例相对罕见的肺淋巴瘤转移至下颌下腺的病例，其中经支气管活检标本及支气管肺泡灌洗中淋巴细胞的分析有助于确诊。
