小児に発生した回腸原発悪性リンパ腫の1例

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A 5-year-old boy was admitted with several days history of severe abdominal pain and vomiting. He showed tenderness and muscle guarding on lower abdomen, and pelvic mass was palpable on rectal digital examination. Acute appendicitis was suspected and emergent operation was performed. At laparotomy, we found pelvic tumor composed of the ileum, rectal and bladder wall. As mesenteric nodes showed marked swelling, we suspected malignant tumor. Because pathologic diagnosis on frozen sections was inflammation, we excised the perforated ileum only. However, final pathologic diagnosis was non-Hodgikin's malignant lymphoma, large cell type, hence radiation and chemotherapy including VCR, Prednisolone, L-asparaginase, 6-MP, MTX were added. Now, seven months after the operation, he is well without evidence of recurrent disease. Between January 1, 1967 and Decembar 31, 1982, 41 cases of malignant lymphoma were admitted to the National Children's Hospital, four cases (10%) of which originated from the ileum. This case was operated on suspicion of acute appendicitis, and other three cases were operated for intussusception secondary to the disease. When the child is reffered for abdominal pain, especially in the case of intussusception seen in a child elder than 2 years old, malignant lymphoma should be taken into account of, although those of the ileum are very rare.
1983-12-20