위 MALT 림프종에서 다발성 림프절 전이로 오인된 동시성 림프절 결핵 1예 = A Case of Synchronous Tuberculous Lymphadenitis Appearing Like Multiple Metastatic Node in a Patient with Gastric Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma

국문 초록 (Abstract)

28세 남자가 내시경적 점막절제술을 통해 저등급 위MALT 림프종으로 진단되었다. 병기설정을 위해 18F-FDG PET 검사를 시행하였고 우측 쇄골상부, 우측상/하부 기관주위, AP window 부위에 강한 섭취가 관찰되어 전이성 림프절로 판단하였다. 그러나, 우측 쇄골상부 림프절에서 시행한 절제생검에서 만성육아종성염증소견이 관찰되었고 조직의 결핵 중합효소연쇄반응에서도 양성 반응을 보였다. 2개월간 항결핵제의 사용 후 시행한 추적 컴퓨터단층촬영 검사에서 림프절 크기의 감소를 보여 최종적으로 위 MALT 림프종에서 광범위 림프절 전이로 오인된 동시성 림프절 결핵으로 진단되었다.

다국어 초록 (Multilingual Abstract)

A 28-year-old man was diagnosed as gastric MALT lymphoma in diagnostic EMR (endoscopic mucosal resection). He subsequently underwent an 18F-FDG PET. 18F-FDG PET showed intense multifocal uptake in right supraclavicular, right upper and lower paratracheal, and AP window areas that was considered radiologically to represent widespread metastatic lymphadenopathy. Excisional biopsy of a supraclavicular lymph node, however, revealed chronic granulomatous lymphadenitis with a positive reaction of Tb-nested PCR. After antituberculosis treatment for 2 months, a follow-up CT scan showed complete resolution of the lesions. Intense 18F-FDG uptake could be due to an infectious process such as synchronous tuberculous lymphadenitis. Therefore, this could mimic a malignant condition such as lymphoma with extensive lymph node metastasis due to a false-positive finding, which may lead to a misdiagnosis.

목차 (Table of Contents)

• 서론
• 증례
• 고찰
• 국문요약
• 참고문헌

참고문헌 (Reference)

1 보건복지부, "제7차 전국 결핵 실태 조사결과"

2 Kahl BS, "Update, gastric MALTlymphoma" 15 : 347-352, 2003

3 Youn JC, "Two cases of low grade gastric-mucosa-associated lymphoid tissue lymphoma treated by EMR" 64 : 456-460, 2006

4 Wotherspoon AC, "Regression of primary low-grade B-cell gastric lymphoma of mucosa-associated lymphoid tissue type after eradication of Helicobacter pylori" 342 : 575-577, 1993

5 Bayerdörffer E, "Regression of primary gastric lymphoma of mucosa-associated lymphoid tissue type after cure of Helicobacter pylori infection. MALT Lymphoma Study Group" 345 : 1591-1594, 1995

6 Weber DM, "Regression of gastric lymphoma of mucosa-associated lymphoid tissue with antibiotic therapy for Helicobacter pylori" 107 : 1835-1838, 1994

7 Taal BG, "Primary non-Hodgkin’s lymphoma of the stomach: endoscopic pattern and prognosis in low- versus high-grade malignancy in relation to the MALT concept" 39 : 556-561, 1996

8 Thieblemont C, "Mucosa-associated lymphoid tissue lymphomas" 7 : 415-420, 1995

9 Wotherspoon AC, "Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma" 338 : 1175-1176, 1991

10 Toyoda H, "Gastric mucosa-associated lymphoid tissue lymphoma with a focal high-grade component diagnosed by EUS and endoscopic mucosal resection for histologic evaluation" 51 : 752-755, 2000

11 Bakheet SM, "F-18-FDG uptake in tuberculosis" 23 : 739-742, 1998

12 Bakheet SM, "F-18-FDG uptake in tuberculosis" 23 : 739-742, 1998

13 Enomoto K, "F-18 FDG PET imaging of cervical tuberculous lymphadenitis" 32 : 474-475, 2007

14 Rhee JC, "Esophagus, Stomach &Intestine; Endoscopic Findings of Gastric Mucosa: Associated Lymphoid Tissue (MALT) Lymphoma" 17 : 125-113, 1997

15 Chen YK, "Abnormal FDG PET imaging in tuberculosis appearing like lymphoma" 29 : 124-, 2004

16 Park KS, "A Case of Duodenal Tuberculosis Conceived as Submucosal Tumor Accompanied by Tuberculous Lymphadenitis" 23 : 230-234, 2001