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下顎骨骨髄から発生したと考えられた巨大な悪性リンパ腫の１例
山田, 珠希;栗林, 和代;大廣, 洋一;篠原, 早紀;松田, 光平;鈴木, 豊典;北村, 哲也;進藤, 正信;鄭, 漢忠
Permalink : http://hdl.handle.net/2115/60955
KEYWORDS : Malignant lymphoma;non-Hodgkin’s lymphoma;inflammatory disease;diffuse large B-cell lymphoma;mandible;悪性リンパ腫;非ホジキンリンパ腫;炎症性疾患;びまん性大細胞性B細胞リンパ腫;下顎骨
Abstract
顎顔面領域に発症する悪性リンパ腫の顎骨における発生は極めてまれである．今回われわれは下顎骨骨髄から発生した悪性リンパ腫の１例を経験したので報告する． 患者は59歳，男性．2014年９月に右耳下腺咬筋部の腫脹を自覚し，その後腫脹の増大傾向を認めたため，10月に病院歯科口腔外科を受診した．同院では臨床所見ならびに画像所見から歯に起因する炎症性疾患と診断され，抗菌薬による消炎処置後，原因歯の抜歯術が施された．腫脹は一時改善傾向を示したが，その後再燃したため，腫瘍性病変が疑われ2015年１月に紹介受診した．初診時の口腔外所見では顔貌左右非対称で右耳下腺咬筋部に弾性硬の著明な腫脹を認め，右オトガイ部皮膚と下唇に知覚鈍麻を認めた．口腔内所見では右頬粘膜下に腫瘤性病変を認めたが，表面を被覆する粘膜は正常であった．画像検査では右下顎骨体，下顎枝，下顎頭の骨髄内からその周囲に比較的境界明瞭な腫瘤性病変を認め，また，皮質骨全体に点状の骨欠損を認めた．PET-CT検査では腫瘤と一致した部位にSUV max 22.5の集積亢進を認めた．臨床検査所見では特記すべき所見は認められなかった．下顎骨骨髄由来の腫瘍の臨床診断のもと，右頬粘膜部から腫瘤性病変の生検を行い，びまん性大細胞性B細胞リンパ腫と診断された．血液内科に対診し，R-COHP療法ならびに放射線治療により寛解が得られ，現在血液内科にて経過観察中である．
Malignant lymphoma arising in the mandible is extremely rare. In this study we report on a case of malignant lymphoma arising in the bone marrow of the mandible. The patient was a 59-year-old man. In September 2014, he noticed a swelling in the right parotid masseteric region. The swelling was getting bigger, and thereafter he visited an oral surgeon’s hospital in October, 2014. In the hospital, antibiotics were administered and he had the diagnosis of an odontogenic inflammation from clinical and imaging findings. The swelling was improved temporarily, but the symptom recurred soon. Other diseases, including lesions, were suspected. He was then referred to our hospital. At the first visit, an extra-oral examination showed facial asymmetry caused by the swelling and hypoesthesia of the right mental region and lower lip. An intraoral examination showed a mass under the right normal buccal mucosa. Contrast enhanced CT and an MRI showed irregular and punctate bone resorption in the cortical bone of the right mandible and uniformly enhanced soft tissue. PET-CT revealed an abnormal uptake in the right mandible region (SUV max : 22.5). In blood tests there were no apparent abnormalities. Biopsy of the tissue showed diffuse large B-cell lymphoma. He received chemotherapy with R-CHOP and irradiation at the department of hematology. He has remained in remission six months after treatment.
Malignant lymphoma arising in the mandible is extremely rare. In this study we report on a case of malignant lymphoma arising in the bone marrow of the mandible. The patient was a 59-year-old man. In September 2014, he noticed a swelling in the right parotid masseteric region. The swelling was getting bigger, and thereafter he visited an oral surgeon’s hospital in October, 2014. In the hospital, antibiotics were administered and he had the diagnosis of an odontogenic inflammation from clinical and imaging findings. The swelling was improved temporarily, but the symptom recurred soon. Other diseases, including lesions, were suspected. He was then referred to our hospital. At the first visit, an extra-oral examination showed facial asymmetry caused by the swelling and hypoesthesia of the right mental region and lower lip. An intraoral examination showed a mass under the right normal buccal mucosa. Contrast enhanced CT and an MRI showed irregular and punctate bone resorption in the cortical bone of the right mandible and uniformly enhanced soft tissue. PET-CT revealed an abnormal uptake in the right mandible region (SUV max : 22.5). In blood tests there were no apparent abnormalities. Biopsy of the tissue showed diffuse large B-cell lymphoma. He received chemotherapy with R-CHOP and irradiation at the department of hematology. He has remained in remission six months after treatment.
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