抄録
The patient was a 56-year-old man who had been exposed to the atomic bomb within 1km from the hypocenter when he was 22 years old in Hiroshima in 1945. After the expsure, general malaise and nausea were observed for three months. In 1970, non-Hodgkin's lymphoma (NHL) (diffuse, histiocytic) of the cervical lymph node (Stage I) occurred. Radical operation was performed and followed by the radiotherapy (6,000 rad, 200 KV X-ray) for five weeks. Thereafter, the patient had been asymptomatic and hematologically normal except that the radiotherapy (7,000 rad, cobalt-60) was delivered again for a right axillary mass lesion which occurred in 1975. In 1979, however, he was readmitted due to increasing general malaise and anemia. On admission, the hemoglobin was 5.9g/100ml, the platelet count 3.3×104/cmm, and leukocyte count 4,100/cmm with 6% blastoid cells and 43% monocytoid cells. The bone marrow aspirate yielded 39.8% blasts and 16.6% monocytoid cells, which were stained for both non-specific esterase (31%) and naphthol AS-D chloroacetate esterase (45%). Serum lysozyme was slightly elvated. From these data the diagnosis of acute myelomonocytic leukemia (AMMoL) was made.
This is a very rare case of an atomic bomb survivor in whom NHL and AMMoL occurred 25 and 34 years later, respectively. On the genesis of these hemopoietic neoplasms, the influence of the exposure to the atomic bomb and/or radiation therapy are presumed.
