四年後白血化し瀰慢性混合型の卵巣を伴う瀰慢性小細胞型リンパ腫に変化した〓胞性中細胞型リンパ腫の1例

抄録

Forty eight-year-old man complained of lymphnodes swelling and was diagnosed as follicular lymphoma, medium sized cell (FM) by lymphnode biopsy in June 1977. After admission for combination therapy, lymphadenopathy subsided and he was discharged in April 1978. He was admitted 4 times thereafter for the therapy of some infections or relaps of lymphadenopathy. In May 1981, anemia progressed rapidly and the blood picture became leukemic. Leukemic cells were small, well differentiated with scanty cytoplasm and many of them had cleaved nuclei. They showed B cell origin by surface marker study. The second biopsy also revealed follicular lymphoma in which the nodular pattern was partly blurred and some tumor cells in follicular architecture altered to large cells. Though his symptome was improved by treatment, hepatomegaly and jaundice appeared in Sep. 1981. He died from perforation of gastric ulcer in Feb. 1982. Autopsy revealed massive proliferation of diffuse small cell type lymphoma (DS) in the retroperitoneum and there were several large foci of diffuse mixed type lymphoma (DMX) in or near the tumor mass of DS. No full and detailed reports of such a dual histological alteration of FM have been known. It was speculated that these serial histological alterations were caused by tumorous differentiation of primary clone of FM to DS and coexisted DMX.