Mantle Cell Lymphoma with Diffuse Gastrointestinal Tract Involvement: A Case Report

廣泛胃腸道侵犯之被套細胞淋巴瘤(mantle cell lymphoma)：一個病例報告

林明宗(Ming-Tzung Lin) ； 郭垣宏(Yuan-Hung Kuo) ； 蔡成枝(Seng-Kee Chuah) ； 邱逸群(Yi-Chun Chiu) ； 黃昭誠(Chao-Cheng Huang) ； 戴維震(Wei-Chen Tai) ； 陳建宏(Chien-Hung Chen) ； 李全謨(Chuan-Mo Lee)

《內科學誌》 20卷6期 (2009/12) Pp. 555-560

https://doi.org/10.6314/JIMT.2009.20(6).11

摘要

被套細胞淋巴瘤(mantle cell lymphoma)占了非何杰金氏淋巴瘤(non-Hodgkin lymphoma)的百分之五到十，而其中約有百分之二十侵犯到胃腸道。多發性淋巴息肉症(multiple lymphomatous polyposis)是一種少見的疾病。一般認爲它是被套細胞淋巴瘤的一種腸道表現。其表徵以多發性，小息肉樣病灶爲主而同時併有胃與大腸的大息肉樣腫瘤者更爲罕見。我們報告一個罹患的70歲女性主訴腹痛，腹脹與六個月之內體重減輕超過十一公斤。胃鏡發現胃的底部和大腸鏡發現盲腸處都有表面潰瘍的大息肉樣的腫瘤，兩者切片之後確定都是被套細胞淋巴瘤。腹部電腦斷層檢查所見爲廣泛性的胃腸壁增厚，腸繫膜淋巴結之侵犯。患者接受了三次的化學治療包括COP (cyclophosphamide, vincristine, and prednisone)和六次的CP(cyclophosphamide, prednisone)而且搭配七次的Rituximab的治療並獲得顯著的治療效果。胃腸道被套細胞淋巴瘤的內視鏡表徵主要以多發性淋巴息肉症表現。偶爾也有單一的大息肉樣腫瘤病灶的病例，但同時併有多發性胃與大腸的大息肉樣腫瘤者相當罕見。

並列摘要

Gastrointestinal tract mantle cell lymphoma accounts for only approximately 1% to 2% of non-Hodgkin lymphomas. Multiple lymphomatous polyposis is an uncommon disease entity that is regarded as the intestinal form of mantle cell lymphoma. We present here a case of mantle cell lymphoma with peculiar endoscopic presentations in the stomach and colon in a 70 year-old woman. She suffered from abdominal pain, progressive abdominal fullness, and body weight loss of 11 kilograms within 6 months. Big polypoid masses with ulcerations were found at the fundus and high body of the stomach by endoscopy and at the cecal area by colonoscopy. Biopsies from both sites confirmed the diagnosis of mantle cell lymphoma. Computer tomography of the abdomen revealed diffuse wall thickening involving the gastric fundus, high body, antrum, duodenum and proximal ascending colon with extensive mesentery lymph node enlargement. She received one cycle of cyclophosphamide, vincristine and prednisone (COP) followed by seven cycles of rituximab plus cyclophosphamide and prednisone, which resulted in significant tumor regression and prompt symptomatic palliation.

並列關鍵字

Mantle cell lymphoma ； Non-Hodgkin lymphomas ； Multiple lymphomatous polyposis ； Rare endoscopic presentations