胸水ADAが高値を示し,結核性胸膜炎との鑑別を要した胸膜原発悪性リンパ腫の1例

A case of primary pleural malignant lymphoma accompanied with high ADA level in pleural effusion

Creators Murata Yoriyuki

Creators Aoe Keisuke

Creators Utsunomiya Toshiaki

Creators Sakamoto Kenji

Creators Oishi Keiji

Creators Kohtoku Wataru

Creators Chikamori Kenichi

Creators Maeda Tadashi

Creators Okabe Kazunori

Creators Murakami Tomoyuki

Creators Yano Masafumi

Creators Ueoka Hiroshi

症例は73歳女性.入院2ヵ月前から咳嗽と体重減少があり,入院3日前に近医にて胸部単純X線写真で右胸水を指摘され,当院に入院となった.胸腔穿刺の結果はリンパ球優位の滲出性胸水であったが,胸水細胞診は3回とも陰性であった.抗酸菌塗抹や結核菌PCRは陰性だが,ADAが50.1IU/Lと高値であり,結核性胸膜炎を疑って抗結核薬の投与を開始した.しかし治療開始後も胸水は減少せず血清の可溶性IL-2受容体が3030IU/Lと高値で,胸部造影CTで右下葉縦隔側に腫瘤様陰影を認めたため,悪性リンパ腫を疑って胸腔鏡下胸膜生検を施行した.壁側胸膜に顆粒状の結節,右下葉臓側胸膜に手拳大の腫瘤を認め,同部位の生検にて,CD20陽性のびまん性大細胞型B細胞リンパ腫(DLBCL)と診断され,PET-CTでは縦隔リンパ節や胸膜に集積を認めたが,他臓器には明らかな集積は無く,胸膜原発と考えた.化学療法としてR-CHOPを施行したところ,胸水や腫瘤は消退し,治療終了後2年以上経過しているが,寛解を維持している.

A 73-year-old woman was hospitalized due to cough and weight loss. Chest radiograph revealed a right pleural effusion. The pleural effusion was exudative, predominantly consisting of lymphocytes. Cytological examination of pleural effusion revealed no malignant cells. As adenosine deaminase levels in of pleural effusion were elevated(50.1 IU/l),we suspected that the patient had tuberculous pleurisy and initiated anti-tuberculosis therapy, however the pleural effusion did not resolve. Subsequently, high levels of serum soluble interleukin-2 receptor(3030 IU/l)were observed. Chest computed tomography(CT)revealed a mass in the lower lobe of the right lung, suggesting malignant lymphoma. Thoracoscopy was then performed under general anesthesia

[ISSN]0513-1731

[NCID]AN00243156