進行病期マントル細胞リンパ腫と結核性胸水の同時発症
症例は70代後半の男性，病期IV のマントル細胞リンパ腫と左優位の胸水を同時発症した．リンパ節生検では，中型細胞がびまん性に増殖し，免疫染色では，腫瘍細胞はCD5，CD20，CD79a，BCL2，サイクリンD1，SOX11 陽性，CD3，CD10陰性であった．染色体・FISH検査で t(11;14)(q13;q32)/IGH::CCND1転座を認め，IGHV 遺伝子はminimally mutatedであった．リンパ腫病変は，全身リンパ節，脾臓，膵頭部，胃，十二指腸，骨髄に認められた．ベンダムスチンとリツキシマブを 1 サイクル，シクロホスファミド，ドキソルビシン，ビンクリスチン，リツキシマブ...
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| Published in | 天理医学紀要 Vol. 26; no. 2; pp. 99 - 109 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English Japanese |
| Published |
公益財団法人 天理よろづ相談所 医学研究所
25.12.2023
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1344-1817 2187-2244 |
| DOI | 10.12936/tenrikiyo.26-013 |
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| Abstract | 症例は70代後半の男性，病期IV のマントル細胞リンパ腫と左優位の胸水を同時発症した．リンパ節生検では，中型細胞がびまん性に増殖し，免疫染色では，腫瘍細胞はCD5，CD20，CD79a，BCL2，サイクリンD1，SOX11 陽性，CD3，CD10陰性であった．染色体・FISH検査で t(11;14)(q13;q32)/IGH::CCND1転座を認め，IGHV 遺伝子はminimally mutatedであった．リンパ腫病変は，全身リンパ節，脾臓，膵頭部，胃，十二指腸，骨髄に認められた．ベンダムスチンとリツキシマブを 1 サイクル，シクロホスファミド，ドキソルビシン，ビンクリスチン，リツキシマブを 1 サイクル実施したところ表在リンパ節腫脹は縮小したが，胸水は改善しなかった．胸水から作製したZeel-Neelsen染色塗抹標本の顕微鏡検査でごく少数の抗酸菌を認め，結核菌のPCR検査が陽性であった．リファンピシン，イソニアジド，ピラジナミド，エタンブトールによる抗結核治療を実施したところ胸水は速やかに消失した．初診から5年経過したが、マントル細胞リンパ腫と胸水のいずれも再発を認めない．悪性リンパ腫患者は結核を発症するリスクが高いので，リンパ腫に胸水を伴った場合は，必ずしも腫瘍性胸水ではないことに留意する必要がある． |
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| AbstractList | 症例は70代後半の男性，病期IV のマントル細胞リンパ腫と左優位の胸水を同時発症した．リンパ節生検では，中型細胞がびまん性に増殖し，免疫染色では，腫瘍細胞はCD5，CD20，CD79a，BCL2，サイクリンD1，SOX11 陽性，CD3，CD10陰性であった．染色体・FISH検査で t(11;14)(q13;q32)/IGH::CCND1転座を認め，IGHV 遺伝子はminimally mutatedであった．リンパ腫病変は，全身リンパ節，脾臓，膵頭部，胃，十二指腸，骨髄に認められた．ベンダムスチンとリツキシマブを 1 サイクル，シクロホスファミド，ドキソルビシン，ビンクリスチン，リツキシマブを 1 サイクル実施したところ表在リンパ節腫脹は縮小したが，胸水は改善しなかった．胸水から作製したZeel-Neelsen染色塗抹標本の顕微鏡検査でごく少数の抗酸菌を認め，結核菌のPCR検査が陽性であった．リファンピシン，イソニアジド，ピラジナミド，エタンブトールによる抗結核治療を実施したところ胸水は速やかに消失した．初診から5年経過したが、マントル細胞リンパ腫と胸水のいずれも再発を認めない．悪性リンパ腫患者は結核を発症するリスクが高いので，リンパ腫に胸水を伴った場合は，必ずしも腫瘍性胸水ではないことに留意する必要がある． |
| Author | 林田, 雅彦 稲尾, 崇 岸森, 千幸 福塚, 勝弘 小谷, 槙一 住吉, 真治 前川, ふみよ 大野, 仁嗣 阿部, 教行 |
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| References | 14. Orchard J, Garand R, Davis Z, et al. A subset of t(11;14) lymphoma with mantle cell features displays mutated IgVH genes and includes patients with good prognosis, nonnodal disease. Blood 2003;101:4975-4981. 22. Hadzidimitriou A, Agathangelidis A, Darzentas N, et al. Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases. Blood 2011;118:3088-3095. 10. Freedman AS, Aster JC. Mantle cell lymphoma: Epidemiology, pathobiology, clinical manifestations, diagnosis, and prognosis. In: Lister A, LaCasce AS, eds. UpToDate (accessed on June 10, 2023). 12. Ye H, Desai A, Zeng D, et al. Smoldering mantle cell lymphoma. J Exp Clin Cancer Res 2017;36:185. 21. Kienle D, Kröber A, Katzenberger T, et al. VH mutation status and VDJ rearrangement structure in mantle cell lymphoma: correlation with genomic aberrations, clinical characteristics, and outcome. Blood 2003;102:3003-3009. 7. Navarro A, Clot G, Royo C, et al. Molecular subsets of mantle cell lymphoma defined by the IGHV mutational status and SOX11 expression have distinct biologic and clinical features. Cancer Res 2012;72:5307-5316. 16. Abrisqueta P, Scott DW, Slack GW, et al. Observation as the initial management strategy in patients with mantle cell lymphoma. Ann Oncol 2017;28:2489-2495. 4. Falagas ME, Kouranos VD, Athanassa Z, et al. Tuberculosis and malignancy. Qjm 2010;103:461-487. 20. Camacho FI, Algara P, Rodríguez A, et al. Molecular heterogeneity in MCL defined by the use of specific VH genes and the frequency of somatic mutations. Blood 2003;101:4042-4046. 13. Nadeu F, Martin-Garcia D, Clot G, et al. Genomic and epigenomic insights into the origin, pathogenesis, and clinical behavior of mantle cell lymphoma subtypes. Blood 2020;136:1419-1432. 2. Anai S, Hashisako M, Ikegame S, et al. Mantle cell lymphoma involvement of the pleura and tuberculous pleurisy with pulmonary tuberculosis: a case report and literature review. J Infect Chemother 2012;18:258-264. 19. Navarro A, Beà S, Jares P, et al. Molecular pathogenesis of mantle cell lymphoma. Hematol Oncol Clin North Am 2020;34:795-807. 6. van Dongen JJ, Langerak AW, Brüggemann M, et al. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia 2003;17:2257-2317. 5. Silva FA, Matos JO, de QMFC, et al. Risk factors for and attributable mortality from tuberculosis in patients with hematologic malignances. Haematologica 2005;90:1110-1115. 18. Nakahama K, Kaneda H, Ogawa K, et al. Safe concurrent use of anti-tuberculosis drugs and pembrolizumab in a patient with non-small-cell lung cancer who was infected with Mycobacterium tuberculosis. Intern Med 2022;61:1039-1042. 8. Chopra A, Huggins JT. Tuberculous pleural effusion. In: Bernardo J, ed. UpToDate (accessed on June 10, 2023). 15. Carvajal-Cuenca A, Sua LF, Silva NM, et al. In situ mantle cell lymphoma: clinical implications of an incidental finding with indolent clinical behavior. Haematologica 2012;97:270-278. 9. Shaw JA, Irusen EM, Diacon AH, et al. Pleural tuberculosis: A concise clinical review. Clin Respir J 2018;12:1779-1786. 1. Dobler CC, Cheung K, Nguyen J, et al. Risk of tuberculosis in patients with solid cancers and haematological malignancies: a systematic review and meta-analysis. Eur Respir J 2017;50. 3. Ganzel C, Silverman B, Chemtob D, et al. The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study. Leuk Lymphoma 2019;60:720-725. 17. Kumar A, Ying Z, Alperovich A, et al. Clinical presentation determines selection of patients for initial observation in mantle cell lymphoma. Haematologica 2019;104:e163-e166. 11. Wilson MR, Barrett A, Cheah CY, et al. How I manage mantle cell lymphoma: indolent versus aggressive disease. Br J Haematol 2023;201:185-198. |
| References_xml | – reference: 14. Orchard J, Garand R, Davis Z, et al. A subset of t(11;14) lymphoma with mantle cell features displays mutated IgVH genes and includes patients with good prognosis, nonnodal disease. Blood 2003;101:4975-4981. – reference: 12. Ye H, Desai A, Zeng D, et al. Smoldering mantle cell lymphoma. J Exp Clin Cancer Res 2017;36:185. – reference: 13. Nadeu F, Martin-Garcia D, Clot G, et al. Genomic and epigenomic insights into the origin, pathogenesis, and clinical behavior of mantle cell lymphoma subtypes. Blood 2020;136:1419-1432. – reference: 17. Kumar A, Ying Z, Alperovich A, et al. Clinical presentation determines selection of patients for initial observation in mantle cell lymphoma. Haematologica 2019;104:e163-e166. – reference: 20. Camacho FI, Algara P, Rodríguez A, et al. Molecular heterogeneity in MCL defined by the use of specific VH genes and the frequency of somatic mutations. Blood 2003;101:4042-4046. – reference: 22. Hadzidimitriou A, Agathangelidis A, Darzentas N, et al. Is there a role for antigen selection in mantle cell lymphoma? Immunogenetic support from a series of 807 cases. Blood 2011;118:3088-3095. – reference: 6. van Dongen JJ, Langerak AW, Brüggemann M, et al. Design and standardization of PCR primers and protocols for detection of clonal immunoglobulin and T-cell receptor gene recombinations in suspect lymphoproliferations: report of the BIOMED-2 Concerted Action BMH4-CT98-3936. Leukemia 2003;17:2257-2317. – reference: 8. Chopra A, Huggins JT. Tuberculous pleural effusion. In: Bernardo J, ed. UpToDate (accessed on June 10, 2023). – reference: 15. Carvajal-Cuenca A, Sua LF, Silva NM, et al. In situ mantle cell lymphoma: clinical implications of an incidental finding with indolent clinical behavior. Haematologica 2012;97:270-278. – reference: 19. Navarro A, Beà S, Jares P, et al. Molecular pathogenesis of mantle cell lymphoma. Hematol Oncol Clin North Am 2020;34:795-807. – reference: 10. Freedman AS, Aster JC. Mantle cell lymphoma: Epidemiology, pathobiology, clinical manifestations, diagnosis, and prognosis. In: Lister A, LaCasce AS, eds. UpToDate (accessed on June 10, 2023). – reference: 2. Anai S, Hashisako M, Ikegame S, et al. Mantle cell lymphoma involvement of the pleura and tuberculous pleurisy with pulmonary tuberculosis: a case report and literature review. J Infect Chemother 2012;18:258-264. – reference: 18. Nakahama K, Kaneda H, Ogawa K, et al. Safe concurrent use of anti-tuberculosis drugs and pembrolizumab in a patient with non-small-cell lung cancer who was infected with Mycobacterium tuberculosis. Intern Med 2022;61:1039-1042. – reference: 5. Silva FA, Matos JO, de QMFC, et al. Risk factors for and attributable mortality from tuberculosis in patients with hematologic malignances. Haematologica 2005;90:1110-1115. – reference: 21. Kienle D, Kröber A, Katzenberger T, et al. VH mutation status and VDJ rearrangement structure in mantle cell lymphoma: correlation with genomic aberrations, clinical characteristics, and outcome. Blood 2003;102:3003-3009. – reference: 16. Abrisqueta P, Scott DW, Slack GW, et al. Observation as the initial management strategy in patients with mantle cell lymphoma. Ann Oncol 2017;28:2489-2495. – reference: 11. Wilson MR, Barrett A, Cheah CY, et al. How I manage mantle cell lymphoma: indolent versus aggressive disease. Br J Haematol 2023;201:185-198. – reference: 3. Ganzel C, Silverman B, Chemtob D, et al. The risk of tuberculosis in cancer patients is greatest in lymphoma and myelodysplastic syndrome/myeloproliferative neoplasm: a large population-based cohort study. Leuk Lymphoma 2019;60:720-725. – reference: 4. Falagas ME, Kouranos VD, Athanassa Z, et al. Tuberculosis and malignancy. Qjm 2010;103:461-487. – reference: 7. Navarro A, Clot G, Royo C, et al. Molecular subsets of mantle cell lymphoma defined by the IGHV mutational status and SOX11 expression have distinct biologic and clinical features. Cancer Res 2012;72:5307-5316. – reference: 1. Dobler CC, Cheung K, Nguyen J, et al. Risk of tuberculosis in patients with solid cancers and haematological malignancies: a systematic review and meta-analysis. Eur Respir J 2017;50. – reference: 9. Shaw JA, Irusen EM, Diacon AH, et al. Pleural tuberculosis: A concise clinical review. Clin Respir J 2018;12:1779-1786. |
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| Snippet | 症例は70代後半の男性，病期IV のマントル細胞リンパ腫と左優位の胸水を同時発症した．リンパ節生検では，中型細胞がびまん性に増殖し，免疫染色では，腫瘍細... |
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| SubjectTerms | minimally mutated IGHV3-53 マントル細胞リンパ腫 塗抹標本・PCR検査 結核性胸水 長期無再発生存 |
| Title | 進行病期マントル細胞リンパ腫と結核性胸水の同時発症 |
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