内容紹介
Primary Small Intestinal Burkitt Lymphoma Treated with Rituximab-Combined CODOX-M/IVAC Therapy without Surgical Resection
Summary
A 38-year-old man complaining of abdominal pain was admitted to our hospital and diagnosed with small bowel obstruction. Whole body computed tomography(CT)scan showed moderate right pleural effusion with pleural and anterior chest wall thickening, with a mass approximately 100 mm in diameter at the terminal ileum. Histopathological and immunohistorical analysis of the endoscopic biopsy from the terminal ileum mass revealed diffuse infiltration of medium-sized, monotonous, atypical B lymphocytes with scanty basophilic cytoplasms carrying the so-called“starry sky”appearance, and primary small intestinal Burkitt lymphoma(BL)was diagnosed. Because of his advanced clinical stage(stageⅣ with Ann Arbor staging system)and the need for immediate treatment, he was promptly treated with cyclophosphamide and doxorubicin without surgical resection. Fortunately this initial therapy was received without the occurrence of bowel perforation. After initiating additional rituximab combined high-dose chemotherapy consisting of alternating courses of rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate(R-CODOX-M)and rituximab, ifosfamide, etoposide, and cytarabine(R-IVAC), he achieved complete remission and remains without signs of disease now more than seven years after his last treatment. While further investigation will of course be needed, if possible, immediate chemotherapy without surgical resection is a treatment worth considering for improving the prognosis of those with small intestinal BL.
要旨
症例は38歳,男性。腹痛,腸閉塞で発症。全身CTで右胸水と前胸壁下,横隔膜,腹膜の肥厚および回腸末端に10 cmの腫瘤を認め,大腸内視鏡検査による生検で小腸Burkitt lymphoma(BL)と診断した。臨床病期はstageⅣA期。病変は進行が速く,また腸管外にも認めたため病変部の腸管を切除せず,病勢コントロールのためcyclophosphamideとdoxorubicinを投与した。腸管穿孔は起こらず,腸閉塞は改善したためrituximabを併用し,CODOX-M/IVAC療法を行った。病変は消失し,その後化学療法を行っていないが8年間寛解を保っている。小腸BLに対する迅速な対応が予後を改善した1例と考える。
目次
Summary
A 38-year-old man complaining of abdominal pain was admitted to our hospital and diagnosed with small bowel obstruction. Whole body computed tomography(CT)scan showed moderate right pleural effusion with pleural and anterior chest wall thickening, with a mass approximately 100 mm in diameter at the terminal ileum. Histopathological and immunohistorical analysis of the endoscopic biopsy from the terminal ileum mass revealed diffuse infiltration of medium-sized, monotonous, atypical B lymphocytes with scanty basophilic cytoplasms carrying the so-called“starry sky”appearance, and primary small intestinal Burkitt lymphoma(BL)was diagnosed. Because of his advanced clinical stage(stageⅣ with Ann Arbor staging system)and the need for immediate treatment, he was promptly treated with cyclophosphamide and doxorubicin without surgical resection. Fortunately this initial therapy was received without the occurrence of bowel perforation. After initiating additional rituximab combined high-dose chemotherapy consisting of alternating courses of rituximab, cyclophosphamide, vincristine, doxorubicin, and methotrexate(R-CODOX-M)and rituximab, ifosfamide, etoposide, and cytarabine(R-IVAC), he achieved complete remission and remains without signs of disease now more than seven years after his last treatment. While further investigation will of course be needed, if possible, immediate chemotherapy without surgical resection is a treatment worth considering for improving the prognosis of those with small intestinal BL.
要旨
症例は38歳,男性。腹痛,腸閉塞で発症。全身CTで右胸水と前胸壁下,横隔膜,腹膜の肥厚および回腸末端に10 cmの腫瘤を認め,大腸内視鏡検査による生検で小腸Burkitt lymphoma(BL)と診断した。臨床病期はstageⅣA期。病変は進行が速く,また腸管外にも認めたため病変部の腸管を切除せず,病勢コントロールのためcyclophosphamideとdoxorubicinを投与した。腸管穿孔は起こらず,腸閉塞は改善したためrituximabを併用し,CODOX-M/IVAC療法を行った。病変は消失し,その後化学療法を行っていないが8年間寛解を保っている。小腸BLに対する迅速な対応が予後を改善した1例と考える。