Aomatsu Naoki, Uchima Yasutake, Aoyama Yasutaka, Tsujio Gen, Wang En, Yamakoshi Yoshihito, Nagashima Daisuke, Hirakawa Toshiki, Iwauchi Takehiko, Nishii Takafumi, Nakazawa Kazunori, Tei Seika, Takeuchi Kazuhiro
Dept. of Surgery, Fuchu Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):1833-1835.
An 85-year-old man presented to the emergency department with vomiting. He had tenderness in the left abdomen and under the umbilicus. Laboratory data showed an increase in the inflammatory response. Enhanced abdominal computed tomography showed thickening ofthe small intestinal wall in the lower left abdomen with a small amount ofadjacent free air. The fat tissue around the small intestine also revealed a high density area suggestive of inflammation. A diagnosis of peritonitis caused by intestinal perforation was made and an emergency operation was performed. We resected part of the ileum about 90 cm from the ileum end. The resected specimen showed a 1 by 1 cm mass with an ulcer and perforation at the base of the tumor. Histopathological findings revealed densely increased numbers of monomorphic medium-sized lymphoma cells infiltrating into all layers ofthe intestine. Immunohistochemically, the lymphocytes were positive for CD3, CD20, CD30, and CD79a. We diagnosed diffuse large B-cell lymphoma. Two cycles ofchemotherapy were given post-operatively. A recurrence was not observed. After chemotherapy he was transferred to rehabilitation.
一名85岁男性因呕吐就诊于急诊科。他左下腹和脐下有压痛。实验室检查数据显示炎症反应增强。腹部增强计算机断层扫描显示左下腹小肠壁增厚，伴有少量邻近游离气体。小肠周围的脂肪组织也显示出高密度区域，提示有炎症。诊断为肠穿孔引起的腹膜炎，并进行了急诊手术。我们从回肠末端切除了约90厘米的部分回肠。切除的标本显示有一个1×1厘米的肿块，肿瘤底部有溃疡和穿孔。组织病理学检查结果显示大量单形性中等大小淋巴瘤细胞密集浸润肠壁各层。免疫组化显示淋巴细胞CD3、CD20、CD30和CD79a呈阳性。我们诊断为弥漫性大B细胞淋巴瘤。术后给予两个周期的化疗。未观察到复发。化疗后他被转至康复科。
