ラクナ梗塞様症状で発症し血管内大細胞型B細胞リンパ腫と診断した1例
症例は，突然の左失調性片麻痺で発症した79歳男性．頭部MRI拡散強調画像で右内包後脚に高信号病変を認め，ラクナ梗塞の診断で入院した．高血圧などの脳梗塞の危険因子はなかった．微熱があり，貧血と血小板低値を認め，血清LDH，CRPが高値だった．追加検査で可溶性インターロイキン2受容体が高値であったため悪性リンパ腫を疑い，老人性血管腫からの皮膚生検で血管内大細胞型B細胞リンパ腫（intravascular large B-cell lymphoma，以下IVLBCLと略記）と診断した．典型的なラクナ梗塞様症状で発症したIVLBCLの症例で鑑別上重要な症例と考える．...
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| Published in | 臨床神経学 Vol. 62; no. 6; pp. 492 - 495 |
|---|---|
| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
日本神経学会
2022
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0009-918X 1882-0654 |
| DOI | 10.5692/clinicalneurol.cn-001704 |
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| Abstract | 症例は，突然の左失調性片麻痺で発症した79歳男性．頭部MRI拡散強調画像で右内包後脚に高信号病変を認め，ラクナ梗塞の診断で入院した．高血圧などの脳梗塞の危険因子はなかった．微熱があり，貧血と血小板低値を認め，血清LDH，CRPが高値だった．追加検査で可溶性インターロイキン2受容体が高値であったため悪性リンパ腫を疑い，老人性血管腫からの皮膚生検で血管内大細胞型B細胞リンパ腫（intravascular large B-cell lymphoma，以下IVLBCLと略記）と診断した．典型的なラクナ梗塞様症状で発症したIVLBCLの症例で鑑別上重要な症例と考える． |
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| AbstractList | 症例は，突然の左失調性片麻痺で発症した79歳男性．頭部MRI拡散強調画像で右内包後脚に高信号病変を認め，ラクナ梗塞の診断で入院した．高血圧などの脳梗塞の危険因子はなかった．微熱があり，貧血と血小板低値を認め，血清LDH，CRPが高値だった．追加検査で可溶性インターロイキン2受容体が高値であったため悪性リンパ腫を疑い，老人性血管腫からの皮膚生検で血管内大細胞型B細胞リンパ腫（intravascular large B-cell lymphoma，以下IVLBCLと略記）と診断した．典型的なラクナ梗塞様症状で発症したIVLBCLの症例で鑑別上重要な症例と考える． |
| Author | 梅森, 幸恵 藤田, 信也 本郷, 祥子 横田, 一樹 梅田, 麻衣子 土田, 拓睦 |
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| References | 3) Yamamoto A, Kikuchi Y, Homma K, et al. Characteristics of intravascular large B-Cell lymphoma on cerebral MR imaging. AJNR 2012;33:292-296. 7) Sawada T, Omuro Y, Kobayashi T, et al. Long-term complete remission in a patient with intravascular large B-cell lymphoma with central nervous system involvement. Onco Targets Ther 2014;7:2133-2136. 5) 辻浩史，望月昭英，保坂愛ら．亜急性の意識障害を主徴としたintravascular lymphomatisisの62歳女性例．臨床神経 2008;48:328-332. 6) Matsue K, Abe Y, Narita K, et al. Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years. BJHaem 2019;187:328-336. 1) Ponzoni M, Campo E, Nakamura S. Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks. Blood 2018;132:1561-1567. 9) Sakurai T, Wakida K, Takahashi T, et al. Usefulness of senile hemangioma biopsy for diagnosis of intravascular large B-cell lymphoma: a report of two cases and a literature review. J Neurol Sci 2017;373:52-54. 8) Komori T, Narabayashi I, Matsumura K, et al. 2-[Fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience. Ann Nucl Med 2007;21:209-215. 10) 北原匠，石川正典，梅森幸恵ら．ランダム皮膚生検が陰性で，老人性血管腫の生検で診断し得た血管内大細胞型B細胞リンパ腫の1例．脳神経内科 2021;94:270-273. 2) Shimada K, Kinoshita T, Naoe T, et al. Presentation and management of intravascular large B-cell lymphoma. Lancet Oncol 2009;10:895-902. 4) Alexander H, Silke V, Michael K, et al. Intravascular lymphomatosis presenting as rapidly progressive dementia. Eur Neurol 2005;1:55-58. |
| References_xml | – reference: 5) 辻浩史，望月昭英，保坂愛ら．亜急性の意識障害を主徴としたintravascular lymphomatisisの62歳女性例．臨床神経 2008;48:328-332. – reference: 7) Sawada T, Omuro Y, Kobayashi T, et al. Long-term complete remission in a patient with intravascular large B-cell lymphoma with central nervous system involvement. Onco Targets Ther 2014;7:2133-2136. – reference: 2) Shimada K, Kinoshita T, Naoe T, et al. Presentation and management of intravascular large B-cell lymphoma. Lancet Oncol 2009;10:895-902. – reference: 6) Matsue K, Abe Y, Narita K, et al. Diagnosis of intravascular large B cell lymphoma: novel insights into clinicopathological features from 42 patients at a single institution over 20 years. BJHaem 2019;187:328-336. – reference: 10) 北原匠，石川正典，梅森幸恵ら．ランダム皮膚生検が陰性で，老人性血管腫の生検で診断し得た血管内大細胞型B細胞リンパ腫の1例．脳神経内科 2021;94:270-273. – reference: 1) Ponzoni M, Campo E, Nakamura S. Intravascular large B-cell lymphoma: a chameleon with multiple faces and many masks. Blood 2018;132:1561-1567. – reference: 8) Komori T, Narabayashi I, Matsumura K, et al. 2-[Fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography versus whole-body diffusion-weighted MRI for detection of malignant lesions: initial experience. Ann Nucl Med 2007;21:209-215. – reference: 3) Yamamoto A, Kikuchi Y, Homma K, et al. Characteristics of intravascular large B-Cell lymphoma on cerebral MR imaging. AJNR 2012;33:292-296. – reference: 4) Alexander H, Silke V, Michael K, et al. Intravascular lymphomatosis presenting as rapidly progressive dementia. Eur Neurol 2005;1:55-58. – reference: 9) Sakurai T, Wakida K, Takahashi T, et al. Usefulness of senile hemangioma biopsy for diagnosis of intravascular large B-cell lymphoma: a report of two cases and a literature review. J Neurol Sci 2017;373:52-54. |
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| Title | ラクナ梗塞様症状で発症し血管内大細胞型B細胞リンパ腫と診断した1例 |
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