内容紹介
A Case of Extranodal Nasal Type, NK/T Cell Lymphoma in the Ileum with Perforated Peritonitis during Chemotherapy
Summary
A 65-year-old woman complaining of melena and a high fever was admitted to our hospital. Colonoscopy revealed a large tumor with a wide ulcer in the terminal ileum, and nasal type, extranodal NK/T cell lymphoma was suspected via biopsy. Owing to rapid progression of hepatocellular damage with hepatomegaly and splenomegaly, chemotherapy with CHOP was initiated immediately. Two days later, the patient developed panperitonitis, and emergency laparotomy was performed. The tumor in the terminal ileum widely adhered to the bladder, where a deep perforated ulcer was found, for which palliative ileocecal resection was performed. Enlargement of the residual tumor caused an abdominal abscess, intestinal obstruction, and hepatic failure, and the patient died 75 days after surgery. In summary, we initiated chemotherapy to control the deteriorating systemic condition of the patient. However, nasal type, extranodal NK/T cell lymphoma is a rapidly progressing lymphoma occasionally accompanied by perforation of the tumor. Surgery preceding chemotherapy should be considered an alternative treatment.
要旨
症例は65歳,女性。下血,発熱を主訴に当院消化器内科に紹介となった。下部消化管内視鏡検査で回腸末端に広範な潰瘍形成を伴う腫瘍を認めた。生検でextranodal NK/T cell lymphoma,nasal type疑いとなったが,肝脾腫を伴って急激に増悪する肝細胞障害を認めたため,可及的にCHOP療法を開始したが,2日目に穿孔性腹膜炎の診断で緊急手術を施行した。術後,徐々に全身状態悪化し第75病日に死亡した。本症例では,全身的な病勢コントロール目的に化学療法を先行したが,extranodal NK/T cell lymphoma,nasal typeでは腫瘍穿孔などの急激な経過をたどることがあるため,手術を先行することも選択肢の一つであると考えられた。
目次
Summary
A 65-year-old woman complaining of melena and a high fever was admitted to our hospital. Colonoscopy revealed a large tumor with a wide ulcer in the terminal ileum, and nasal type, extranodal NK/T cell lymphoma was suspected via biopsy. Owing to rapid progression of hepatocellular damage with hepatomegaly and splenomegaly, chemotherapy with CHOP was initiated immediately. Two days later, the patient developed panperitonitis, and emergency laparotomy was performed. The tumor in the terminal ileum widely adhered to the bladder, where a deep perforated ulcer was found, for which palliative ileocecal resection was performed. Enlargement of the residual tumor caused an abdominal abscess, intestinal obstruction, and hepatic failure, and the patient died 75 days after surgery. In summary, we initiated chemotherapy to control the deteriorating systemic condition of the patient. However, nasal type, extranodal NK/T cell lymphoma is a rapidly progressing lymphoma occasionally accompanied by perforation of the tumor. Surgery preceding chemotherapy should be considered an alternative treatment.
要旨
症例は65歳,女性。下血,発熱を主訴に当院消化器内科に紹介となった。下部消化管内視鏡検査で回腸末端に広範な潰瘍形成を伴う腫瘍を認めた。生検でextranodal NK/T cell lymphoma,nasal type疑いとなったが,肝脾腫を伴って急激に増悪する肝細胞障害を認めたため,可及的にCHOP療法を開始したが,2日目に穿孔性腹膜炎の診断で緊急手術を施行した。術後,徐々に全身状態悪化し第75病日に死亡した。本症例では,全身的な病勢コントロール目的に化学療法を先行したが,extranodal NK/T cell lymphoma,nasal typeでは腫瘍穿孔などの急激な経過をたどることがあるため,手術を先行することも選択肢の一つであると考えられた。