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Permalink : https://petit.lib.yamaguchi-u.ac.jp/18548
山口医学 Volume 57 Issue 2-3
published_at 2008-06-30
A case of malignant lymphoma with bone marrow necrosis
骨髄壊死を伴った悪性リンパ腫の1症例
About This Article
Descriptions
72歳,男性が発熱,腰痛,全身倦怠感を訴えて来院した.患者は6年前に他院にて瀰漫性大細胞型B細胞性リンパ腫と診断され化学療法にて寛解に導入されたが,5年後リンパ腫は再発し再度の化学療法にて部分寛解に導入された.当院初診時の検査所見では貧血,LDH,sIL2Rの著増,D-dimerの増加を認めた.骨髄穿刺,骨髄生検にて壊死細胞のみ採取された.MRIでは脊椎椎体はT1で巣状にlow intensityを呈した.感染症は否定的であった.これらの症状および検査所見は骨髄壊死に特徴的でありリンパ腫の再燃により合併したと考えられた.CHOP,R-CHOP,THP-COPなどの化学療法を開始したところ一時的に血液像は改善し,骨髄穿刺は可能になり造血細胞も少数認められた.しかし最終的には効果はなく約3ヵ月後に多臓器不全にて死亡した.剖検ではリンパ腫の進展,リンパ腫細胞の骨髄への浸潤および多発性の骨髄壊死が認められた.骨髄壊死の発症の機序としてはリンパ腫細胞の骨髄浸潤,DIC,炎症性サイトカインなどの関与が示唆された.
Creator Keywords
骨髄壊死
悪性リンパ腫
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