膀胱原発Mucosa-associated lymphoid tissue(MALT)リンパ腫の1例

Abstract

85歳女性.患者は肉眼的血尿, 排尿時痛で受診となった.所見では, CTで膀胱前壁から右側壁にかけて7.5×3.0cmの充実性腫瘤を認め, MRIでは腫瘤はT1でlow, T2でhigh intensityを呈し, 膀胱周囲の脂肪層は保れていた.Gaシンチでは膀胱に集積を認めたが, 転移を疑う所見はなかった.また膀胱鏡では膀胱前壁から右側壁にかけて周囲粘膜と同色調の立ち上がりなだらかな腫瘤性病変が認められ, 粘膜面には異常を認めなかった.確定診断のためTUR-biopsyを行なったところ, 小型の単一な異型リンパ球のびまん性浸潤を認め, LCA陽性, B細胞マーカー陽性, T細胞マーカー陰性で, 病理診断はMucosa-associated lymphoid tissue(MALT)リンパ腫であった.膀胱原発悪性リンパ腫と診断し, 放射線療法を施行した結果, 治療開始5ヵ月後時点で, 腫瘍は5.0×1.0cmに縮小し, 28ヵ月経過で腫瘍の増大, 浸潤, 転移は認めていない

A 85-year-old woman presented with macroscopic hematuria and miction pain. Cystoscopy revealed a wide-based submucosal mass, and biopsied specimens of the mass showed a B-cell lymphoma of the MALT type. Computed tomography (CT) showed a 7.5 x 3.0 cm solitary mass lesion situated from the anterior wall to the right lateral bladder wall, and magnetic resonance imaging (MRI) showed a low intensity in T1W1, high in T2W1 without invasion. After she was admitted to our hospital, TUR of the lesion was performed. The findings were consistent with extranodal marginal zone B-cell lymphoma of the MALT type. No evidence of lymphoma was found on the CT of the pelvis, chest X-ray and Gallium scintigraphy. The patient had stages IAE lymphoma. The patient was treated with radiation therapy to the bladder and pelvis (40 Gy in 20 fractions) and was followed with CT every 3 months. She had no evidence of recurrance.