1 愛媛県立中央病院検査部Department of Clinical Laboratory, Ehime Prefectural Central Hospital
2 愛媛県立中央病院血液内科Department of Hematology, Ehime Prefectural Central Hospital
3 愛媛県立中央病院病理診断部Department of Pathology, Ehime Prefectural Central Hospital
目的：悪性リンパ腫肝浸潤のBモード所見とドプラ所見における特徴的所見の有無について検討したので報告する．
対象と方法：当院で2011年1月から2015年12月に腹部超音波検査を施行し，生検もしくは肝切除標本の病理組織診で悪性リンパ腫と確定診断された11例（男性8例，女性3例，年齢中央値83歳）をretrospectiveに検討した．組織型の内訳は，びまん性大細胞型B細胞リンパ腫8例，粘膜関連リンパ組織型節外性辺縁帯リンパ腫1例，メトトレキサート関連リンパ増殖性疾患1例，Hodgkinリンパ腫1例であった．
結果と考察：腫瘤径30 mm（≧30 mm：6例，＜30 mm：5例）を境に，Bモード所見およびドプラ所見の違いがみられた．最大径が30 mm以上の腫瘤は，内部エコーが不均一な低エコーで，腫瘤内部に線状高エコーや点状高エコーがみられた．また，カラードプラでは，腫瘤内部に正常血管の貫通像がみられた．一方，最大径が30 mm未満の腫瘤は，内部エコーが均一な低エコーで，腫瘤内部に脈管貫通像がみられなかった．悪性リンパ腫の組織型の違いによる超音波所見の違いはみられなかった．
結論：悪性リンパ腫肝浸潤の超音波所見は，腫瘤径30 mmを境に異なる可能性がある．Bモードで腫瘤径を加味して内部エコーを評価し，さらにカラードプラで脈管貫通像の有無を評価することで，悪性リンパ腫肝浸潤の超音波鑑別診断能が向上する可能性が示唆された．
Purpose: This study was conducted to examine whether there are characteristic findings of hepatic malignant lymphoma on B-mode and Doppler ultrasonography.
Subjects and Methods: Eleven patients (8 men and 3 women, median age 83 years) who were diagnosed with malignant lymphoma by biopsy or hepatectomy after ultrasonography between January 2011 and December 2015 were analyzed retrospectively. Histologically, there were 8 diffuse large B-cell lymphomas, 1 extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue, 1 methotrexate-associated lymphoproliferative disorder and 1 Hodgkin lymphoma.
Results and Discussion: There was a significant difference in B-mode findings and Doppler findings between tumors with diameters of ≧30 mm and those with diameters of ＜30 mm (≧30 mm: 6 cases, ＜30 mm: 5 cases). Tumors with a diameter of ≧30 mm appeared as hypoechoic masses with heterogeneous internal echo, with linear or dotted hyperechoic images. On color Doppler, penetration of normal vessels was observed inside the tumor. Tumors a diameter of ＜30 mm appeared as hypoechoic masses with homogeneous internal echo, and displayed images that were not suggestive of vascular penetration. Histopathological characteristics did not correlate with ultrasonographic findings in any of the cases.
Conclusion: We conclude that the ultrasonographic findings of hepatic malignant lymphoma might vary with a diameter of 30 mm. It was suggested that the ultrasonographic differential diagnosis capability of hepatic malignant lymphomas might be improved by assessing the tumor diameter and the internal echo on B-mode and by evaluating the presence or absence of the vascular penetrating image on color Doppler.
Key words: hepatic malignant lymphoma; ultrasonography; doppler
© 2018 一般社団法人日本超音波検査学会© 2018 Japanese Society of Sonographers
This page was created on 2017-12-18T16:36:42.679+09:00
This page was last modified on 2018-02-05T11:17:29.84+09:00
このサイトは（株）国際文献社によって運用されています。
