胃と腸49巻5号

2014年05月発行

増刊号 消化管悪性リンパ腫2014 主題 消化管原発aggressive lymphoma―diffuse large B-cell lymphoma

DLBCLの病理

著者： 諸橋聡子¹ 吉澤忠司¹ 平井秀明¹ 鳥羽崇仁² 羽賀敏博³ 櫻庭伸悟⁴ 岡野健介⁴ 清野浩子¹ 呉雲燕¹ 鬼島宏¹

所属機関： ¹弘前大学大学院医学研究科病理生命科学講座 ²東邦大学医療センター大森病院消化器内科 ³弘前大学医学部消化器内科学講座 ⁴弘前大学医学部消化器外科学講座

ページ範囲：P.699 - P.709

DLBCL（diffuse large B-cell lymphoma）は，非常に発育が早く，予後不良の特徴を有する悪性リンパ腫である．したがって，その病理診断は，的確かつ早急になされる必要がある．DLBCLは，肉眼的に潰瘍形成を伴う腫瘤性病変を呈することが多い．腫瘍表層には壊死物質が存在するため，その生検部位には工夫が必要である．DLBCLの発育伸展様式をその他の腫瘍と比較検討し，理解を深めることにより，的確なDLBCLの生検部位を確認する．さらに，消化管悪性リンパ腫の亜型について言及する．

参考文献

1）吉野正．胃リンパ腫．深山正久，大倉康男（編）．腫瘍病理鑑別診断アトラス―胃癌．文光堂，pp 171-182，2009

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

3）Nakamura S, Matsumoto T, Takeshita M, et al. A clinicopathologic study of primary small intestine lymphoma : prognostic significance of mucosa-associated lymphoid tissue-derived lymphoma. Cancer 88 : 286-294, 2000

4）Sato Y, Ichimura K, Tanaka T, et al. Duodenal follicular lymphomas share common characteristics with mucosa-associated lymphoid tissue lymphomas. J Clin Pathol 61 : 377-381, 2008

5）Bosman FT, Carneiro F, Hruban RH, et al（eds）. WHO Classification of Tumours of Digestive System, 4th ed. IARC, Lyon, 2010

6）小池盛男．悪性リンパ腫．向井清，真鍋俊明，深山正久（編）．外科病理学，4版．文光堂，pp 589-594, 2006

7）Kohno S, Ohshima K, Yoneda S, et al. Clinicopathological analysis of 143 primary malignant lymphomas in the small and large intestines based on the new WHO classification. Histopathology 43 : 135-143, 2003

8）Oyama T, Ichimura K, Suzuki R, et al. Senile EBV＋B-cell lymphoproliferative disorders : a clinicopathologic study of 22 patients. Am J Surg Pathol 27 : 16-26, 2003

9）Oyama T, Yamamoto K, Asano N, et al. Age-related EBV-associated B-cell lymphoproliferative disorders constitute a distinct clinicopathologic group : a study of 96 patients. Clin Cancer Res 13 : 5124-5132, 2007

10）Alizadeh AA, Eisen MB, Davis RE, et al. Distinct types of diffuse large B-cell lymphoma identified by gene expression profiling. Nature 403 : 503-511, 2000

11）Hans CP, Weisenburger DD, Greiner TC, et al. Confirmation of the molecular classification of diffuse large B-cell lymphoma by immunohistochemistry using a tissue microarray. Blood 103 : 275-282, 2004

12）Saito B, Shiozawa E, Usui T, et al. Rituximab with chemotherapy improves survival of non-germinal center type untreated diffuse large B-cell lymphoma. Leukemia 21 : 2563-2566, 2007

13）Winter JN, Weller EA, Horning SJ, et al. Prognostic significance of Bcl-6 protein expression in DLBCL treated with CHOP or R-CHOP : a prospective correlative study. Blood 107 : 4207-4213, 2006

14）Costa LJ, Feldman AL, Micallef IN, et al. Germinal center B（GCB）and non-GCB cell-like diffuse large B cell lymphomas have similar outcomes following autologous haematopoietic stem cell transplantation. Br J Haematol 142 : 404-412, 2008

15）Morito T, Fujihara M, Asaoku H, et al. Serum soluble interleukin-2 receptor level and immunophenotype are prognostic factors for patients with diffuse large B-cell lymphoma. Cancer Sci 100 : 1255-1260, 2009

16）Ferrucci PF, Zucca E. Primary gastric lymphoma pathogenesis and treatment : what has changed over the past 10 years ? Br J Haematol 36 : 521-538, 2007 Epub 2006/12/13.

17）Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach : clinical presentation, diagnostic pitfalls and management. Ann Oncol 19 : 1992-1999, 2008

18）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

19）Macpherson N, Lesack D, Klasa R, et al. Small noncleaved, non-Burkitt's（Burkit-Like）lymphoma : cytogenetics predict outcome and reflect clinical presentation. J Clin Oncol 17 : 1558-1567, 1999

20）Tomita N, Tokunaka M, Nakamura N, et al. Clinicopathological features of lymphoma/leukemia patients carrying both BCL2 and MYC translocations. Haematologica 94 : 935-943, 2009

21）Hirano K, Yamashita K, Yamashita N, et al. Non-Hodgkin's lymphoma in a patient with probable hereditary nonpolyposis colon cancer : report of a case and review of the literature. Dis Colon Rectum 45 : 273-279, 2002

22）Pineda M, Castellsague E, Musulen E, et al. Non-Hodgkin lymphoma related to hereditary nonpolyposis colorectal cancer in a patient with a novel heterozygous complex deletion in the MSH2 gene. Genes Chromosomes Cancer 47 : 326-332, 2008