Sato Koichi, Suga Tomoaki, Hirayama Atsuhiro, Daikuhara Seiichi, Uehara Takeshi, Tanaka Eiji
Division of Gastroenterology and Hepatology, Department of Medicine, Shinshu University School of Medicine, Matsumoto, Japan.
Endoscopic Examination Center, Shinshu University Hospital, 3-1-1 Asahi, Matsumoto, 390-8621, Japan.
Clin J Gastroenterol. 2020 Feb;13(1):1-5. doi: 10.1007/s12328-019-01026-1. Epub 2019 Jul 26.
A 52-year-old woman was treated for colorectal diffuse large B-cell lymphoma (DLBCL) after a prolonged treatment period of azathioprine (AZA) and infliximab (IFX) for Crohn's disease (CD). She had been diagnosed as having colonic CD at the age of 24 years and received AZA from age 29. IFX was added at 47 years of age. She experienced massive hematochezia and anal pain at the age of 52 years and was transferred to our hospital. Endoscopic examination revealed a deep rectal ulcer with arterial bleeding. A stoma constructed at the transverse colon for refractory CD relieved her symptoms. Four months later, computed tomography showed increased thickness of the rectal wall. DLBCL was diagnosed from biopsy specimens of the rectum. Treatment with 6 courses of rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone along with additional radiation therapy for remnant rectal lymphoma has resulted in complete remission for over 5 years. Although colorectal malignant lymphoma coexisting with active CD was rare and the lesions were difficult to detect, intensive therapy for CD helped in the diagnosis and successful treatment of the patient.
一名52岁女性在接受了长期的硫唑嘌呤（AZA）和英夫利昔单抗（IFX）治疗克罗恩病（CD）后，被诊断为结直肠弥漫性大B细胞淋巴瘤（DLBCL）。她24岁时被诊断为结肠CD，29岁开始接受AZA治疗。47岁时加用IFX。52岁时，她出现大量便血和肛门疼痛，随后被转诊至我院。内镜检查发现直肠深部溃疡伴动脉出血。因难治性CD在横结肠造口后症状缓解。4个月后，计算机断层扫描显示直肠壁增厚。从直肠活检标本中诊断出DLBCL。采用利妥昔单抗联合环磷酰胺、多柔比星、长春新碱和泼尼松龙进行6个疗程的治疗，并对残留的直肠淋巴瘤进行额外的放射治疗，已实现5年多的完全缓解。尽管结直肠恶性淋巴瘤与活动性CD并存较为罕见，且病变难以检测，但对CD的强化治疗有助于该患者的诊断和成功治疗。
