胃と腸43巻7号

2008年06月発行

今月の主題 消化管follicular lymphoma―診断と治療戦略

主題

消化管濾胞性リンパ腫の臨床的特徴―MALTリンパ腫およびDLBCLとの比較

著者： 中村昌太郎¹ 松本主之¹ 梁井俊一¹ 具嶋正樹² 原田直樹³ 八尾隆史²⁴ 飯田三雄¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²九州大学大学院医学研究院形態機能病理学 ³九州大学大学院医学研究院病態修復内科学 ⁴順天堂大学医学部人体病理病態学

ページ範囲：P.1067 - P.1079

文献概要

要旨　消化管濾胞性リンパ腫32例の臨床的特徴を，MALTリンパ腫（n＝229）・diffuse large B-cell lymphoma（DLBCL；n＝214）と比較した．濾胞性リンパ腫のうち腸管原発群（n＝17）は，胃原発群（n＝15）と比べ，肉眼型でMLP型，組織ではGrade 1の頻度が高く，complete remission（CR）導入率は低かった．MALTリンパ腫・DLBCLと比較すると，濾胞性リンパ腫では腸管限局例の頻度が高く，病期進行例が多かった．濾胞性リンパ腫の66％で非外科的治療が行われ，CR導入率（66％）はMALTリンパ腫（89％）・DLBCL（85％）より低かった．予後は，DLBCLと同様で，MALTリンパ腫より不良であった．予後因子としては，CR導入の有無のみが有意なevent-free survival規定因子であった．

参考文献

1) Radaszkiewicz T, Dragosics B, Bauer P. Gastrointestinal malignant lymphomas of the mucosa-associated lymphoid tissue:factors relevant to prognosis. Gastroenterology 102:1628-1638, 1992

2) d'Amore F, Brincker H, Grønæk K, et al. Non-Hodgkin's lymphoma of the gastrointestinal tract:a population-based analysis of incidence, geographic distribution, clinicopathologic presentation features, and prognosis. Danish Lymphoma Study Group. J Clin Oncol 12:1673-1684, 1994

3) Liang R, Todd D, Chan TK, et al. Prognostic factors for primary gastrointestinal lymphoma. Hematol Oncol 13:153-163, 1995

4) Yoshino T, Miyake K, Ichimura K, et al. Increased incidence of follicular lymphoma of the duodenum. Am J Surg Pathol 24:688-693, 2000

5) Nakamura S, Matsumoto T, Iida M, et al. Primary gastrointestinal lymphoma in Japan:a clinicopathologic analysis of 455 patients with special reference to its time trends. Cancer 97:2462-2473, 2003

6) Jaffe ES, Harris NL, Stein H, et al (eds):World Health Organization classification of tumours:Pathology and genetics of tumours of haematopoietic and Lymphoid Tissues, IARC, Lyon, 2001

7) Kodama T, Ohshima K, Nomura K, et al. Lymphomatous polyposis of the gastrointestinal tract, including mantle cell lymphoma, follicular lymphoma and mucosa-associated lymphoid tissue lymphoma. Histopathology 47:467-478, 2005

8) Nakamura S, Ye H, Bacon CM, et al. Gastric MALT lymphoma with t(14;18)(q32;q21)involving IGH and BCL2 genes that responded to Helicobacter pylori eradication. J Clin Pathol 60:1171-1173, 2007

9)中村昌太郎，松本主之，八尾隆史，他．悪性リンパ腫，IPSID．八尾恒良，飯田三雄(編)，小腸疾患の臨床，医学書院，pp 340-351, 2004

10) Rohatiner A, d'Amore F, Coiffier B, et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol 5:397-400, 1994

11)堺勇二，飯田三雄，八尾隆史，他．胃reactive lymphoreticular hyperplasiaの経過観察中に見出された胃悪性リンパ腫の1例．胃と腸 28:1083-1090, 1993

12) LeBrun DP, Kamel OW, Cleary ML, et al. Follicular lymphoma of the gastrointestinal tract:pathologic features in 31 cases and bcl-2 oncogenenic protein expression. Am J Pathol 140:1327-1335, 1992

13) Shia J, Teruya-Feldstein J, Pan D, et al. Primary follicular lymphoma of the gastrointestinal tract:a clinical and pathologic study of 26 cases. Am J Surg Pathol 26:216-224, 2002

14) Damaj G, Verkarre V, Delmer A, et al. Primary follicular lymphoma of the gastrointestinal tract:a study of 25 cases and a literature review. Ann Oncol 14:623-629, 2003

15) Tzankov A, Hittmair A, Müller-Hermelink HK, et al. Primary gastric follicular lymphoma with parafollicular monocytoid B-cells and lymphoepithelial lesions, mimicking extranodal marginal zone lymphoma of MALT. Virchows Arch 441:614-617, 2002

16) Kanda M, Ohshima K, Suzumiya J, et al. Follicular lymphoma of the stomach:immunohistochemical and molecular genetic studies. J Gastroenterol 38:584-587, 2003

17) Nakamura S, Matsumoto T, Umeno J, et al. Endoscopic features of intestinal follicular lymphoma:the value of double-balloon enteroscopy. Endoscopy 39(Suppl 1):E26-E27, 2007

18) Kodama M, Kitadai Y, Shishido T, et al. Primary follicular lymphoma of the gastrointestinal tract:a retrospective case series. Endoscopy 40:343-346, 2008

19) Buske C, Weigert O, Dreyling M, et al. Current status and perspective of antibody therapy in follicular lymphoma. Haematologica 91:104-112, 2006

20) Gribben JG. How I treat indolent lymphoma. Blood 109:4617-4626, 2007

21) Toyoda H, Yamaguchi M, Nakamura S, et al. Regression of primary lymphoma of the ampulla of Vater after eradication of Helicobacter pylori. Gastrointest Endosc 54:92-96, 2001

22) Horning SJ, Rosenberg SA. The natural history of initially untreated low-grade non-Hodgkin's lymphomas. N Engl J Med 311:1471-1475, 1984

23) Montoto S, Davies AJ, Matthews J, et al. Risk of clinical implications of transformation of follicular lymphoma to diffuse large B-cell lymphoma. J Clin Oncol 25:2426-2433, 2007

24) Nakamura S, Ye H, Bacon CM, et al. Clinical impact of genetic aberrations in gastric MALT lymphoma:a comprehensive analysis using interphase fluorescence in situ hybridisation. Gut 56:1358-1363, 2007

25) Nakamura S, Ye H, Bacon CM, et al. Translocations involving the immunoglobulin heavy chain gene locus predict better survival in gastric diffuse large B-cell lymphoma. Clin Cancer Res 14:3002-3010, 2008