頸部リンパ節に多発した胚中心進展性異形成の一例
「緒言」胚中心進展性異形成(Progressive transformation of germinal centers:PTGC)は, 反応性リンパ濾胞過形成を背景とする原因不明のリンパ節腫大病変である1,2. 統計学的には, 非特異的リンパ節炎と臨床診断された腫大リンパ節病変の約3%がPTGCであると言われており3, 頸部リンパ節に単発性に見られることが多い4. 我々は, 頸部リンパ節に多発したリンパ節腫大病変に対し, 画像検査, 病理組織検査, マーカー分析(免疫組織化学染色, フローサイトメトリー)および遺伝子関連検査を行い, PTGCの確定診断を得た1例を経験したので報告する. なお...
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| Published in | Shika Hoshasen Vol. 47; no. 1; pp. 26 - 32 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本歯科放射線学会
2007
日本歯科放射線学会 Japanese Society for Oral and Maxillofacial Radiology |
| Subjects | |
| Online Access | Get full text |
| ISSN | 0389-9705 2185-6311 |
| DOI | 10.11242/dentalradiology.47.26 |
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| Abstract | 「緒言」胚中心進展性異形成(Progressive transformation of germinal centers:PTGC)は, 反応性リンパ濾胞過形成を背景とする原因不明のリンパ節腫大病変である1,2. 統計学的には, 非特異的リンパ節炎と臨床診断された腫大リンパ節病変の約3%がPTGCであると言われており3, 頸部リンパ節に単発性に見られることが多い4. 我々は, 頸部リンパ節に多発したリンパ節腫大病変に対し, 画像検査, 病理組織検査, マーカー分析(免疫組織化学染色, フローサイトメトリー)および遺伝子関連検査を行い, PTGCの確定診断を得た1例を経験したので報告する. なお, PTGCは悪性リンパ腫(malignant Lymphoma:ML)に附随してみられことがあり5, さらに臨床症状や画像所見では両者の鑑別が必ずしも容易ではないことから, 本論文はMLとの鑑別に主眼をおき文献的考察を加えた. |
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| AbstractList | 「緒言」胚中心進展性異形成(Progressive transformation of germinal centers:PTGC)は, 反応性リンパ濾胞過形成を背景とする原因不明のリンパ節腫大病変である1,2. 統計学的には, 非特異的リンパ節炎と臨床診断された腫大リンパ節病変の約3%がPTGCであると言われており3, 頸部リンパ節に単発性に見られることが多い4. 我々は, 頸部リンパ節に多発したリンパ節腫大病変に対し, 画像検査, 病理組織検査, マーカー分析(免疫組織化学染色, フローサイトメトリー)および遺伝子関連検査を行い, PTGCの確定診断を得た1例を経験したので報告する. なお, PTGCは悪性リンパ腫(malignant Lymphoma:ML)に附随してみられことがあり5, さらに臨床症状や画像所見では両者の鑑別が必ずしも容易ではないことから, 本論文はMLとの鑑別に主眼をおき文献的考察を加えた. Progressive Transformation of Germinal Centers (PTGC) represents an asymptomatic persistent lymphadenopathy. We herein report a rare case of PTGC with multiple swollen cervical lymph nodes.The patient was a 42-year-old female, who presented to our hospital with a 5-month history of swollen submandibular lymph nodes. Although the patient had received antibiotic therapy during the past 2 weeks, lymph node swelling persisted. Ultrasonogram of the right submandibular lymph nodes demonstrated homogenous hypoechoic images with echogenic hilus. One of the lymph node showed a scalloped margin. These lymph nodes showed hyperintensity to the submandibular gland on T2-weighted MR Image, isointensity to muscle on T1-weighted MR Image, and homogenous enhancement after contrast administration. Further, swelling of the middle internal jugular nodes was also noted.For the differential diagnosis of malignant lymphoma (ML), biopsy of the swollen lymph node was obtained. The histological features showed follicular hyperplasia with the predominance of small mantle cell B-lymphocytes with resultant disruption and eventual replacement. Flow cytometric analysis did not show the abnormal immunophenotypic pattern, common in ML. On Southern blot analysis, there was neither the immunoglobulin gene nor T-cell receptor gene rearrangement. Furthermore, there were no chromasomal abnormalities. Taking the above findings into account, the lesion was not diagnosed as ML but as PTGC. To date, there have not been any significant changes in cervical lymph nodes on follow-up ultrasonographic images.In conclusion, additional examinations (e.g., flow cytometry, Southern blot, etc.) should be useful to distinguish PTGC from ML, because their clinical and imaging feature were frequently similar. |
| Author | 阪本, 真弥 西岡, 貴志 古内, 寿 示野, 陽一 笹野, 高嗣 庄司, 憲明 小嶋, 郁穂 飯久保, 正弘 菅原, 由美子 |
| Author_FL | Iikubo Masahiro Sakamoto Maya Nishioka Takashi Sugawara Yumiko Shoji Noriaki Shimeno Youichi Sasano Takashi Furuuchi Toshi Kojima Ikuho |
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| References | 6. Kojima M, Nakamura S, Motoori T, Ito H, Shimizu K, Yamane N, Ohno Y, Ban S, Yoshida K, Hoshi K, Oyama T, Shimano S, Sugihara S, Sakata N, Masawa N. Progresive transformation of germinal centers: a clinicopathological study of 42 Japanese patients. Int J Surg Pathol. 2003; 11: 101-107. 13. Biesemier KW, Dent GA, Pryzwansky KB, Folds JD. A comparative study of frozen-section immunoperoxidase and flow cytometry for immunophenotypic analysis of lymph node biopsies. Clin Diagn Lab Immunol. 1994; 1: 299-303. 5. Osborne BM, Butler JJ. Clinical implications of progresive transformation of germinal centers. Am J Surg Pathol. 1984; 8: 725-733. 8. 康本真由美．悪性リンパ腫の画像診断：鑑別診断を中心に．臨床画像．2002；18：737-744 4. Hicks J, Flaitz C. Progresive transformation of germinal centers: review of histopathologic and clinical features. Int J Pediatr Otorhinolaryngol. 2002; 65: 195-202. 7. Osborne BM, Butler JJ, Hicks EB. Progressive transformation of germinal centers: comparison of 23 pediatric patients to the adult population. Mod Pathol. 1992; 5: 135-140. 1. 田丸淳一．胚中心進展性異形成．菊地昌弘，森 茂郎．最新・悪性リンパ腫アトラス 第1版．東京．文光堂．2004：337-339 15. Bergman R, Kurtin PJ, Gibson LE, Hull PR, Kimlinger TK, Schroeter AL. Clinicopathologic, immunophenotypic, and molecular characterization of primary cutaneous follicular B-cell lymphoma. Arch Dermatol. 2001; 137: 432-439. 2. 林 常敏，猟山 大，藤内 祝，上田 実．顎下部に発生した胚中心進展性異形成の1例．日口診誌．2006；19：119-122 10. 酒井 修．頸部リンパ節の画像診断—転移性腫瘍，悪性リンパ腫および非腫瘍性病変—．画像診断．2003；23：1346-1359 9. 井村有希子，南里和秀，米山昌司，戸原瑞樹，梁瀬博文．頸部リンパ節の超音波検査による良悪性の評価．超音波検査技術．2006；31：7-13 12. 畠山重春，松井武寿，岸本浩次．悪性リンパ腫の細胞診断．畠山重春．カラーアトラス・リンパ節細胞診—悪性リンパ腫を中心に—．第1版．東京．医歯薬出版．2005：65-124 3. Hansmann ML, Fellbaum C, Hui PK, Moubayed P. Progressive transformation of germinal centers with and without association to Hodgkin's disease. Am J Clin Pathol. 1990; 93: 219-226. 16. Delabie J, Greiner TC, Chan WC, Weisenburger DD. Concurrent lymphocyte predominance Hodgkin's disease and T-cell lymphoma: a report of three cases. Am J Surg Pathol. 1996; 20: 355-362. 17. Hansmann ML, Gödde-Salz E, Hui PK, Müller-Hermelink HK, Lennert K. Cytogenetic findings in nodular paragranuloma(Hodgkin's disease with lymphocytic predominance; nodular)and in progressively transformed germinal centers. Cancer Genet Cytogenet. 1986; 21: 319-325. 14. Ohno T, Stribley JA, Wu G, Hinrichs SH, Weisenburger DD, Chan WC. Clonality in nodular lymphocyte-predominant Hodgkin's disease. N Engl J Med. 1997; 337: 459-465. 18. Torlakovic EE, Aamot HV, Heim S. A marginal zone phenotype in follicular lymphoma with t(14;18)is associated with secondary cytogenetic aberrations typical of marginal zone lymphoma. J Pathol. 2006; 209: 258-264. 11. 光谷俊幸，岸本浩次．悪性リンパ腫の病理組織分類．畠山重春．カラーアトラス・リンパ節細胞診—悪性リンパ腫を中心に—．第1版．東京．医歯薬出版．2005：25-63 |
| References_xml | – reference: 11. 光谷俊幸，岸本浩次．悪性リンパ腫の病理組織分類．畠山重春．カラーアトラス・リンパ節細胞診—悪性リンパ腫を中心に—．第1版．東京．医歯薬出版．2005：25-63． – reference: 12. 畠山重春，松井武寿，岸本浩次．悪性リンパ腫の細胞診断．畠山重春．カラーアトラス・リンパ節細胞診—悪性リンパ腫を中心に—．第1版．東京．医歯薬出版．2005：65-124． – reference: 18. Torlakovic EE, Aamot HV, Heim S. A marginal zone phenotype in follicular lymphoma with t(14;18)is associated with secondary cytogenetic aberrations typical of marginal zone lymphoma. J Pathol. 2006; 209: 258-264. – reference: 3. Hansmann ML, Fellbaum C, Hui PK, Moubayed P. Progressive transformation of germinal centers with and without association to Hodgkin's disease. Am J Clin Pathol. 1990; 93: 219-226. – reference: 13. Biesemier KW, Dent GA, Pryzwansky KB, Folds JD. A comparative study of frozen-section immunoperoxidase and flow cytometry for immunophenotypic analysis of lymph node biopsies. Clin Diagn Lab Immunol. 1994; 1: 299-303. – reference: 1. 田丸淳一．胚中心進展性異形成．菊地昌弘，森 茂郎．最新・悪性リンパ腫アトラス 第1版．東京．文光堂．2004：337-339． – reference: 2. 林 常敏，猟山 大，藤内 祝，上田 実．顎下部に発生した胚中心進展性異形成の1例．日口診誌．2006；19：119-122． – reference: 7. Osborne BM, Butler JJ, Hicks EB. Progressive transformation of germinal centers: comparison of 23 pediatric patients to the adult population. Mod Pathol. 1992; 5: 135-140. – reference: 5. Osborne BM, Butler JJ. Clinical implications of progresive transformation of germinal centers. Am J Surg Pathol. 1984; 8: 725-733. – reference: 4. Hicks J, Flaitz C. Progresive transformation of germinal centers: review of histopathologic and clinical features. Int J Pediatr Otorhinolaryngol. 2002; 65: 195-202. – reference: 10. 酒井 修．頸部リンパ節の画像診断—転移性腫瘍，悪性リンパ腫および非腫瘍性病変—．画像診断．2003；23：1346-1359． – reference: 17. Hansmann ML, Gödde-Salz E, Hui PK, Müller-Hermelink HK, Lennert K. Cytogenetic findings in nodular paragranuloma(Hodgkin's disease with lymphocytic predominance; nodular)and in progressively transformed germinal centers. Cancer Genet Cytogenet. 1986; 21: 319-325. – reference: 8. 康本真由美．悪性リンパ腫の画像診断：鑑別診断を中心に．臨床画像．2002；18：737-744． – reference: 14. Ohno T, Stribley JA, Wu G, Hinrichs SH, Weisenburger DD, Chan WC. Clonality in nodular lymphocyte-predominant Hodgkin's disease. N Engl J Med. 1997; 337: 459-465. – reference: 6. Kojima M, Nakamura S, Motoori T, Ito H, Shimizu K, Yamane N, Ohno Y, Ban S, Yoshida K, Hoshi K, Oyama T, Shimano S, Sugihara S, Sakata N, Masawa N. Progresive transformation of germinal centers: a clinicopathological study of 42 Japanese patients. Int J Surg Pathol. 2003; 11: 101-107. – reference: 16. Delabie J, Greiner TC, Chan WC, Weisenburger DD. Concurrent lymphocyte predominance Hodgkin's disease and T-cell lymphoma: a report of three cases. Am J Surg Pathol. 1996; 20: 355-362. – reference: 9. 井村有希子，南里和秀，米山昌司，戸原瑞樹，梁瀬博文．頸部リンパ節の超音波検査による良悪性の評価．超音波検査技術．2006；31：7-13． – reference: 15. Bergman R, Kurtin PJ, Gibson LE, Hull PR, Kimlinger TK, Schroeter AL. Clinicopathologic, immunophenotypic, and molecular characterization of primary cutaneous follicular B-cell lymphoma. Arch Dermatol. 2001; 137: 432-439. |
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| Snippet | 「緒言」胚中心進展性異形成(Progressive transformation of germinal centers:PTGC)は, 反応性リンパ濾胞過形成を背景とする原因不明のリンパ節腫大病変である1,2. 統計学... Progressive Transformation of Germinal Centers (PTGC) represents an asymptomatic persistent lymphadenopathy. We herein report a rare case of PTGC with multiple... |
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| SubjectTerms | Cervical lymph node Image diagnosis Pathological diagnosis Progressive transformation of germinal centers 画像診断 病理診断 胚中心進展性異形成 頸部リンパ節 |
| Title | 頸部リンパ節に多発した胚中心進展性異形成の一例 |
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| ispartofPNX | 歯科放射線, 2007, Vol.47(1), pp.26-32 |
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