前立腺原発悪性リンパ腫の1例

Abstract

82歳男.肛門痛を主訴に受診し骨盤部CT及びMRIで前立腺癌を疑われ, 又, 排尿困難及び2ヵ月間で約5kgの体重減少を認めていた為, 精査加療目的に入院となった.入院後, 前立腺生検を施行し, 中等大から大型の異型細胞の瀰漫性増殖を認め, LCA陽性であり, 悪性リンパ腫の可能性が高いと診断された.腫瘍への放射線照射開始後, 腫瘍の縮小と肛門痛の著明改善を認めた.病理組織診断で, 前立腺原発悪性リンパ腫と診断された.放射線療法のみでは予後不良と考え, 多剤併用化学療法を開始したが, その後肺炎を併発し, 抗菌剤の投与等を行ったが呼吸不全が進行し死亡となった

A case of a primary malignant lymphoma of the prostate is presented. An 82-year-old man visited our hospital complaining of anal pain. Digital rectal examination revealed an enlarged prostate gland, which caused a rectal stricture. A computed tomographic scan and magnetic resonance imaging (MRI) showed a large mass arising from the prostate and protruding to the rectum. According to the Working Formulation, he was diagnosed with non-Hodgkin's lymphoma of B-cell origin, diffuse, mixed, small and large cell. The results of bone marrow puncture and imaging studies led to the diagnosis of primary malignant lymphoma of the prostate. Because of poor performance status deriving from severe anal pain, radiation therapy was performed to control the pain. After improvement of his performance status, he received combination chemotherapy consisting of cyclophosphamide, adriamycin, vincristine and predonisone (CHOP regimen). His prostate markedly diminished in size, but pneumonia developed. His respiratory condition rapidly deteriorated, and he died of respiratory failure about two and a half months after the onset of his illness. Malignant lymphoma involving the prostate, whether primary or secondary, is very rare. In our understanding, this case is thought to be the 28th clinical case of a malignant lymphoma of the prostate in Japan.