内容紹介
A Case of Malignant Lymphoma of the Jejunum That Developed Stenosis and Perforation after a Complete Response to Chemotherapy
Summary
A 57-year-old woman was admitted owing to epigastric pain. Abdominal computed tomography demonstrated a tumor in the origin of the jejunum. After an endoscopic biopsy, we diagnosed diffuse large B-cell lymphoma. We treated her with CHOP chemotherapy because pancreaticoduodenectomy is highly invasive. After 1 course of chemotherapy, the tumor was reduced. However, she developed a jejunal stenosis; therefore, we performed laparoscopic gastrojejunostomy. Furthermore, she developed perforated peritonitis on the sixth day after the surgery, and therefore, an emergency partial jejunum resection was performed. Histopathologically, viable lymphoma cells were not found in the resected intestine. She had a complete response 10 months after the surgery. Chemotherapy may cause intestinal stenosis and perforation requiring surgery; therefore, decisions about surgical procedures must be made carefully.
要旨
症例は57歳,女性。主訴は心窩部痛で,CTで空腸起始部に腫瘍を認め,内視鏡的生検により小腸原発びまん性大細胞型B細胞性リンパ腫と診断した。切除には膵頭十二指腸切除を要する可能性があったため,化学療法を選択しCHOP療法を開始した。腫瘍は縮小したが1コース終了後に空腸狭窄を来したため,腹腔鏡下胃空腸バイパス術を施行した。さらに術後6日目に穿孔性腹膜炎を発症し,緊急手術にて小腸部分切除術を施行した。病理組織学的検査で腫瘍細胞は認めなかったため,一連の経過は化学療法の奏効が原因と考えた。退院後R-CHOP療法を施行し,術後10か月で完全寛解状態である。腸管悪性リンパ腫において化学療法奏効による狭窄や穿孔が手術を要する場合があり,病変部位によって慎重に術式を決定する必要がある。
目次
Summary
A 57-year-old woman was admitted owing to epigastric pain. Abdominal computed tomography demonstrated a tumor in the origin of the jejunum. After an endoscopic biopsy, we diagnosed diffuse large B-cell lymphoma. We treated her with CHOP chemotherapy because pancreaticoduodenectomy is highly invasive. After 1 course of chemotherapy, the tumor was reduced. However, she developed a jejunal stenosis; therefore, we performed laparoscopic gastrojejunostomy. Furthermore, she developed perforated peritonitis on the sixth day after the surgery, and therefore, an emergency partial jejunum resection was performed. Histopathologically, viable lymphoma cells were not found in the resected intestine. She had a complete response 10 months after the surgery. Chemotherapy may cause intestinal stenosis and perforation requiring surgery; therefore, decisions about surgical procedures must be made carefully.
要旨
症例は57歳,女性。主訴は心窩部痛で,CTで空腸起始部に腫瘍を認め,内視鏡的生検により小腸原発びまん性大細胞型B細胞性リンパ腫と診断した。切除には膵頭十二指腸切除を要する可能性があったため,化学療法を選択しCHOP療法を開始した。腫瘍は縮小したが1コース終了後に空腸狭窄を来したため,腹腔鏡下胃空腸バイパス術を施行した。さらに術後6日目に穿孔性腹膜炎を発症し,緊急手術にて小腸部分切除術を施行した。病理組織学的検査で腫瘍細胞は認めなかったため,一連の経過は化学療法の奏効が原因と考えた。退院後R-CHOP療法を施行し,術後10か月で完全寛解状態である。腸管悪性リンパ腫において化学療法奏効による狭窄や穿孔が手術を要する場合があり,病変部位によって慎重に術式を決定する必要がある。