Zenda Takahiro, Nakagawa Noriharu, Maruyama Hiroyuki, Endo Tamao, Higashi Kotaro, Yamamoto Junpei, Komai Keigo, Watanabe Kishichiro, Araki Ichiro
Department of Internal Medicine, Asanogawa General Hospital, Kosaka-Naka 83, Kanazawa, 920-8621, Japan.
Department of Hematology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
Clin J Gastroenterol. 2017 Apr;10(2):147-153. doi: 10.1007/s12328-016-0708-x. Epub 2016 Dec 24.
Among the various manifestations of colonic involvement in malignant lymphomas, an ulcerative colitis-like appearance is rare. Herein, we describe a case in which extranodal colonic involvement resembled ulcerative colitis in a patient with advanced follicular lymphoma. A 59-year-old Japanese man with diarrhea and body weight loss was referred to our hospital. Computed tomography (CT) revealed systemic lymphadenopathy, splenomegaly, and thickening of the sigmoid colon and rectum walls. F-fluorodeoxy-glucose positron emission tomography (F-FDG-PET/CT) revealed intense tubular F-FDG accumulation extending from the rectum to the colon at the hepatic flexure and much weaker accumulation in the systemic lymph nodes, bone marrow, and spleen. The isotope-enriched areas had an ulcerative colitis-like appearance as shown via colonoscopy. The patient was ultimately diagnosed with follicular lymphoma (stage IV A, grade 1) based on a pathological examination of the neck lymph nodes, iliac bone marrow, and colon. After six courses of chemotherapy (R-CHOP), F-FDG-PET/CT confirmed complete remission of the lymphoma including the colonic lesion. This is presumably the first case of ulcerative-like colitis caused by a follicular lymphoma. As a novel approach, the lymphoma-related colitis was detected by comparing the pathology results and the F-FDG-PET/CT results.
在恶性淋巴瘤累及结肠的各种表现中，溃疡性结肠炎样外观较为罕见。在此，我们描述一例晚期滤泡性淋巴瘤患者，其结外结肠受累表现类似溃疡性结肠炎。一名59岁的日本男性因腹泻和体重减轻就诊于我院。计算机断层扫描（CT）显示全身淋巴结肿大、脾肿大以及乙状结肠和直肠壁增厚。氟脱氧葡萄糖正电子发射断层扫描（F-FDG-PET/CT）显示从直肠到肝曲结肠有强烈的管状F-FDG积聚，而全身淋巴结、骨髓和脾脏中的积聚则弱得多。结肠镜检查显示，同位素富集区域呈溃疡性结肠炎样外观。根据颈部淋巴结、髂骨骨髓和结肠的病理检查，该患者最终被诊断为滤泡性淋巴瘤（IV A期，1级）。经过六个疗程的化疗（R-CHOP）后，F-FDG-PET/CT证实淋巴瘤包括结肠病变完全缓解。这可能是首例由滤泡性淋巴瘤引起的溃疡性结肠炎样病例。作为一种新方法，通过比较病理结果和F-FDG-PET/CT结果检测出了淋巴瘤相关的结肠炎。
