Plumonary lymphoproliferative disorder ¥ê¥ó¥ÑÁý¿£ÀÇÙ¼À´µ¡¡ †
Ç٤ηëÀá/¼ðáî¾õ¤¢¤ë¤¤¤Ï¤Ó¤Þ¤óÀ¥ê¥ó¥Ñµå·ÏºÙ˦(¥ê¥ó¥Ñµå, ·Á¼ÁºÙ˦¾)¿»½áÁý¿£ÀÉÂÊÑ. È¿±þÀ¤«¼ðáçÀ¤«¤Î¿ÇÃǤξ, IgG4´ØÏ¢¼À´µ¤ämulticentric Castleman disease¤Ê¤ÉÁ´¿ÈÀ¼À´µ¤ÎÇÙÉÂÊѤȤ·¤Æ¸½¤ì, ´ÕÊÌ¿ÇÃǤ¬É¬Íפˤʤë.
Pulmonary lymphoproliferative disorders*1
1. Nodular lymphoid hyperplasia (NLH)
2. MALT/ BALT lymphoma
3. lymphoid interstitial pneumonia (LIP)
4. IgG4 related lung disease
5. multicentric Castleman disease (MCD) --->MCDÇÙÉÂÊѤΥڡ¼¥¸
6. lymphomatoid granulomatosis (LYG) ---> LYG¾ÉÎ㡦²òÀâ¥Ú¡¼¥¸
nodular lymphomatoid hyperplasia (NLH) †
ÉôʬŪ¤ËÀþ°Ý²½¤Îǧ¤á¤é¤ì¤ëæõÃæ¿´¤ò¤â¤Ä¥ê¥ó¥ÑßÉ˦·ÁÀ®¤Î¤á¤À¤ÄËÉ٤ʥê¥ó¥ÑÁÈ¿¥ÁýÀ¸¤«¤é¤Ê¤ë¸Â¶ÉÀÈ¿±þÀÉÂÊÑ.
- µ¶¥ê¥ó¥Ñ¼ð¤È¤è¤Ð¤ì¤Æ¤¤¤¿¤¬, ¾ÉÎã¤Î¤«¤Ê¤ê¤Î¿ô¤¬Ã±¥¯¥í¡¼¥óÀÁý¿£¤ÎMALT¥ê¥ó¥Ñ¼ð¤Ç¤¢¤ê, ¥â¥Î¥¯¥í¡¼¥Ê¥ë¤ÊÁý¿£¤¬¸«¤¤¤À¤»¤Ê¤¤ÉÂÊѤËÂФ·, ÉÂÊÑ̾¤È¤·¤Æ»ÈÍѤ¹¤ë.
- ¶»Ëì²¼ÇÙÁÈ¿¥Æâ¤Ë¶³¦ÌÀÎÆ¤Ê·ëÀ᤬1¸Ä¤Ê¤¤¤·¿ô¸Äǧ¤á¤é¤ì¤ë. 0.5cm°Ê¾å¤Î¥µ¥¤¥º¤Ç5.0cm¤ò¤³¤¨¤ë¤â¤Î¤Ï¤Þ¤ì.
- ¶»Ë켫¿È, µ¤´É»Ù¤Ë±è¤Ã¤¿Ê¬Éۤ϶¯¤¯¤Ê¤¤. ÇÙ˦Êɤ˱è¤Ã¤¿ºÙ˦¿»½á¤Ïǧ¤á¤Ê¤¤.
- ´û¸¤ÎÇÙ¹½Â¤¤òÃÖ´¹¤·¤Æ, æõÃæ¿´¤ò¤â¤Ä¿¿ô¤Î¥ê¥ó¥ÑßÉ˦·ÁÀ®¤Ë¤è¤ë·ëÀá¤ò¼¨¤¹. ¥ê¥ó¥ÑßÉ˦¤Ï°Å, ÌÀÂÓ¤ÎÁؤò¼¨¤¹Àµ¾ïæõÃæ¿´¼þ°Ï¤ò¥Þ¥ó¥È¥ëÂÓ(IgDÍÛÀ)¤¬°Ïå夹¤ë. ßÉ˦´Ö¤Ë¤ÏTºÙ˦¤¬ËÉÙ¤ÇÀµ¾ï¤Ê¥ê¥ó¥ÑÁÈ¿¥Ìȱֹ½Â¤¤òÊݤäƤ¤¤ë.
- À®½Ï¥ê¥ó¥Ñµå, ·Á¼ÁºÙ˦¤¬·ëÀáÀ¤ËÁýÀ¸¤·, ÉÂÊÑÃæ¿´¤Ë¤·¤Ð¤·¤Ð¼ï¡¹¤ÎÄøÅÙ¤ÎÀþ°Ý²½¤òǧ¤á¤ë¤¬²õ»à¤Ï¤ß¤é¤ì¤Ê¤¤.
- ·Á¼ÁºÙ˦¤Ë¤ÏRussell body¤äMott cell¤¬¸«¤é¤ì¤ë. °Û·¿½ê¸«¤Ç¤¢¤ëDutcher body(³ËÆâÉõÆþÂÎ)¤Ï¸«¤é¤ì¤Ê¤¤.
- ¼þ°ÏÇÙÁÈ¿¥¤Ëµ¤¹ÐÆâ´ï¼Á²½(organizing pneumonia:OP)½ê¸«¤¬»¶¸«¤µ¤ì¤ë¤³¤È¤¬¤¢¤ë.
- MALT lymphoma¤Î½ê¸«¤Ç¤¢¤ë, LEL¤äfollicular colonization¤Ï¤Ê¤¤.
- Ìȱ֥°¥í¥Ö¥ê¥óLº¿¤Ïpolyclonal pattern. IgHºÆ¹½À®¤Ï¸¡½Ð¤µ¤ì¤Ê¤¤.
- LIP¤È¤Ï, ÇÙ˦Êɤ˱褦ºÙ˦¿»½á¤Ï·ÚÈù¤Ç¤Ó¤Þ¤óÀÉÂÊѤǤϤʤ¯, ·ëÀáÀ/¼ðáî·ÁÀ®ÀÉÂÊѤǤ¢¤ë¤³¤È¤Ç´ÕÊ̤¹¤ë.