研究者詳細 - 岩室　雅也

論文 - 岩室　雅也

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Helicobacter suis感染胃炎の一例

稲生祥子, 岩室雅也, 田中健大, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

日本消化器病学会中国支部例会プログラム・抄録集 117回 74 - 74 2022年6月

H.pylori未感染胃粘膜を背景に発生したリンパ節転移を伴う低分化型進行胃癌の一例

倉岡紗樹子, 川野誠司, 小橋真由, 岡上昇太郎, 里見拓也, 稲生祥子, 濱田健太, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之, 垣内慶彦, 黒田新士, 藤原俊義, 田中健大, 池田宣聖

日本消化器病学会中国支部例会プログラム・抄録集 117回 75 - 75 2022年6月

Characterization of Gastric Tissue-Resident T Cells in Autoimmune and Helicobacter pylori-Associated Gastritis. 査読国際誌

Daisuke Kametaka, Masaya Iwamuro, Takahide Takahashi, Araki Hirabata, Kenta Hamada, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Takehiro Tanaka, Fumio Otsuka, Yoshiro Kawahara, Hiroyuki Okada

Current issues in molecular biology 44 ( 6 ) 2443 - 2452 2022年5月

担当区分：責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Data regarding the in-depth surface marker profiles of gastric tissue-resident lymphocytes in autoimmune and Helicobacter pylori-associated gastritis are lacking. In this study, we investigated potential differences in lymphocyte composition between these profiles. We enrolled patients with autoimmune (n = 14), active (current infection of H. pylori in the stomach; n = 10), and inactive gastritis (post-eradication of H. pylori; n = 20). Lymphocytes were isolated from the greater curvature of the stomach and lesser curvature of the body and analyzed using flow cytometry. The CD8+/CD3+ and CD4+/CD3+ ratios differed between the samples. Body CD4+/antrum CD4+, which is calculated by dividing the CD4+/CD3+ ratio in the body by that in the antrum, was significantly higher in autoimmune gastritis (3.54 ± 3.13) than in active (1.47 ± 0.41) and inactive gastritis (1.42 ± 0.77). Antrum CD8+/CD4+ in autoimmune gastritis (7.86 ± 7.23) was also higher than that in active (1.49 ± 0.58) and inactive gastritis (2.84 ± 2.17). The area under the receiver operating characteristic curve of antrum CD8+/CD4+ was 0.842, and the corresponding optimal cutoff point was 4.0, with a sensitivity of 71.4% and a specificity of 93.3%. We propose that an antrum CD8+/CD4+ ratio > 4.0 is a potential diagnostic marker for autoimmune gastritis.

DOI： 10.3390/cimb44060167

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A prospective multicenter study of the magnifying endoscopic evaluation of the invasion depth of superficial esophageal cancers. 国際誌

Tatsuhiro Gotoda, Keisuke Hori, Masahiro Nakagawa, Sayo Kobayashi, Tatsuya Toyokawa, Shuhei Ishiyama, Atsushi Imagawa, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Masaya Iwamuro, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Surgical endoscopy 36 ( 5 ) 3451 - 3459 2022年5月

記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: Treatment strategies for superficial esophageal squamous cell carcinoma (SESCC) are determined mainly on the basis of the invasion depth. The Japan Esophageal Society (JES) developed a simplified magnifying endoscopic classification for estimating the invasion depth of SESCC. We aimed to evaluate its accuracy. METHODS: We prospectively applied the JES classification for estimating the invasion depth of SESCC to 204 consecutive lesions from 6 hospitals in Japan between April 2016 and October 2018. We analyzed the accuracy of the endoscopic diagnosis by adding the following two categories to the JES classification: ≥ 7 mm lesion in B2 vessels (defined as B2 ≥ 7 mm) and B2 vessels with inflammation (defined as B2i). RESULTS: After applying the exclusion criteria, 201 lesions remained in the analysis. The diagnostic value of type B1, B2, B3 vessels were as follows: sensitivity, 93.9%, 68.0%, 25.0%; specificity, 81.1%, 89.2%, 99.4%; positive predictive value (PPV), 95.6%, 47.2%, 75.0%; negative predictive value (NPV), 75.0%, 95.1%, 95.4%; and accuracy, 91.5%, 86.5%, 95.0%, respectively. A retrospective analysis showed that the diagnostic accuracy was higher in type B2 vessels (86.5% to 92.0%). An avascular area (AVA) was found in 55 (27%) of the 201 lesions, which tended to be associated with a deeper pathological diagnosis of each Type B vessel. In an additional analysis, B2 ≥ 7 mm and B2i improved the diagnostic accuracy of type B2 vessels from 86.5% to 92.0%. CONCLUSIONS: The JES classification is useful for estimating the invasion depth of SESCC. The diagnostic accuracy for type B2 vessels was low, which may be improved by using B2 ≥ 7 mm and B2i.

DOI： 10.1007/s00464-021-08666-w

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下咽頭ESD後の変形予防にValsalva法が有効であった1例

佐藤大直, 濱田健太, 安部真, 牧野琢丸, 藤澤郁, 岡上昇太郎, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之

日本消化器内視鏡学会中国支部例会 128回 101 - 101 2022年5月

Heller-Dor術後に残存した胸痛に対し、Peroral Endoscopic Myotomyが有効であった食道アカラシアの一例

平田翔一郎, 里見拓也, 濱田健太, 榮浩行, 杉原雄策, 和田薫, 桑井寿雄, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 河野吉泰, 神崎洋光, 岩室雅也, 川野誠司, 河原祥朗, 岡田裕之

日本消化器内視鏡学会中国支部例会 128回 110 - 110 2022年5月

Two Cases of Duodenal Ulcers That Developed after Transcatheter Procedures for Unruptured Visceral Artery Aneurysms 査読

Masaya Iwamuro, Yusuke Kawai, Mayu Uka, Yusuke Matsui, Takao Hiraki, Yoshiro Kawahara, Hiroyuki Okada

Case Reports in Gastrointestinal Medicine 2022 1 - 6 2022年4月

担当区分：筆頭著者,　責任著者掲載種別：研究論文（学術雑誌）出版者・発行元：Hindawi Limited

Herein, we report two cases of duodenal ulcers that developed after transcatheter procedures for the treatment of unruptured artery aneurysms. Both patients recovered after the administration of nothing by mouth, intravenous fluids, and proton-pump inhibitors. Notably, the duodenal ulcer was unchanged in one patient six days after endovascular treatment and improved in the other patient 13 days after angiography. These cases suggest that conservative treatment is acceptable in patients with duodenal ischemia that develops as an adverse effect of endovascular procedures. The usefulness of esophagogastroduodenoscopy in such patients has also been highlighted.

DOI： 10.1155/2022/9988216

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その他リンク： http://downloads.hindawi.com/journals/crigm/2022/9988216.xml

Laminin 511-E8 Fragment Offers Superior Adhesion Properties for Gastric Cancer Cells Compared with Full-Length Laminin 511. 査読国際誌

Masaya Iwamuro, Hidenori Shiraha, Mayu Kobashi, Shigeru Horiguchi, Hiroyuki Okada

Current issues in molecular biology 44 ( 4 ) 1539 - 1551 2022年4月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

BACKGROUND: The interaction between cancer cells and laminin (Ln) is a key event in tumor invasion and metastasis. Previously, we determined the effect of full-length Ln511 on gastric cancer cells. However, the interactions between the Ln511-E8 fragment, a truncated protein of Ln511, and gastric cancer cells have not been investigated. METHODS: We investigated the adhesion properties of gastric cancer cells to full-length Ln511 and Ln511-E8 fragments. RESULTS: The proliferation of four gastric cancer cell lines (SH-10-TC, MKN74, SC-6-JCK, and MKN45) was highest on the Ln511-E8 fragment. Further, a larger cytoplasm was observed in SH-10-TC and MKN74 cells cultured on full-length Ln511 or Ln511-E8 fragments. The percentage of adhesive cells was highest on the Ln511-E8 fragment in all four cell lines. Moreover, adhesion of the gastric cancer cells to Ln511-E8 fragment-coated plates was reduced by the Cdc42 GTPase inhibitor in a dose-dependent manner, suggesting the involvement of Cdc42 in the Ln511-E8 fragment-induced enhanced adhesion of gastric cancer cells. CONCLUSIONS: The Ln511-E8 fragment had a greater impact on the adhesion, morphology, and proliferation of gastric cancer cells than full-length laminin. Thus, the Ln511-E8 fragment is suitable for investigating the interaction between gastric cancer cells and extracellular matrices in tumor invasion and metastasis.

DOI： 10.3390/cimb44040105

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胃穹窿部にみられた扁平上皮化生の1例

岩室雅也, 田中健大, 倉岡紗樹子, 小橋真由, 里見拓也, 岡上昇太郎, 田邊俊介, 藤原敬士, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 64 ( 4 ) 999 - 1004 2022年4月

記述言語：日本語出版者・発行元：(一社)日本消化器内視鏡学会

症例は87歳男性.75歳時に逆流性食道炎に対して下部食道および胃噴門部切除,空腸間置法再建を実施.87歳時の上部消化管内視鏡検査にて,穹窿部に境界明瞭な約10mmの白色調の領域を認め,narrow-band imaging観察では白色～緑色調であり,腺管構造は不明瞭であった.生検にて胃扁平上皮化生と診断した.以後,1年毎に上部消化管内視鏡検査を施行.経過中に扁平上皮化生領域は軽度増大し,92歳時点では地図状の形態となっていた.胃扁平上皮化生が食道粘膜から非連続性に発生することはまれであるが,上記の内視鏡所見を認める場合は,本症を鑑別に挙げるべきと考えられた.(著者抄録)

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チエノピリジン服用者における胃内視鏡的粘膜下層剥離術(ESD)の後出血リスクの検討

平井亮佑, 川野誠司, 稲生祥子, 倉岡紗樹子, 岡上昇太郎, 里見拓也, 濱田健太, 河野吉泰, 神崎洋光, 岩室雅也, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 64 ( Suppl.1 ) 831 - 831 2022年4月

Application of electron microscopy in gastroenterology. 査読国際誌

Masaya Iwamuro, Haruo Urata, Takehiro Tanaka, Hiroyuki Okada

World journal of gastrointestinal pathophysiology 13 ( 2 ) 41 - 49 2022年3月

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Electron microscopy has long been used in research in the fields of life sciences and materials sciences. Transmission and scanning electron microscopy and energy-dispersive X-ray spectroscopy (EDX) analyses have also been performed in the field of gastroenterology. Electron microscopy and EDX enable (1) Observation of ultrastructural differences in esophageal epithelial cells in patients with gastroesophageal reflux and eosinophilic esophagitis; (2) Detection of lanthanum deposition in the stomach and duodenum; (3) Ultrastructural and elemental analyses of enteroliths and bezoars; (4) Detection and characterization of microorganisms in the gastrointestinal tract; (5) Diagnosis of gastrointestinal tumors with neuroendocrine differentiation; and (6) Analysis of gold nanoparticles potentially used in endoscopic photodynamic therapy. This review aims to foster a better understanding of electron microscopy applications by reviewing relevant clinical studies, basic research findings, and the state of current research carried out in gastroenterology science.

DOI： 10.4291/wjgp.v13.i2.41

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潰瘍性大腸炎患者における直腸粘膜内のリンパ球分画構成の検討

岩室雅也, 高橋孝英, 田中健大, 平岡佐規子, 岡田裕之

日本消化管学会雑誌 6 ( Suppl. ) 208 - 208 2022年1月

胃癌と非癌粘膜の白色球状外観(white globe appearance)の差異に関する検討

岩室雅也, 田中健大, 榮浩行, 安部真, 河野吉泰, 神崎洋光, 川野誠司, 河原祥朗, 岡田裕之

Gastroenterological Endoscopy 64 ( 1 ) 29 - 36 2022年1月

記述言語：日本語出版者・発行元：(一社)日本消化器内視鏡学会

【背景・目的】胃癌と非癌粘膜の白色球状外観(white globe appearance:WGA)の違いを明らかにする.【方法】胃WGA症例の内視鏡所見と臨床的特徴を後ろ向きに解析した.【結果】胃癌18例,非癌23例にWGAを認めた.胃癌症例は7例(38.9%),非癌症例は17例(73.9%)がプロトンポンプ阻害剤(proton pump inhibitor:PPI)を内服していた.病理学的には,胃癌症例(18例)のうち腺管の嚢胞状拡張は12例(66.7%),腺腔内壊死物質は12例(66.7%),壁細胞の過形成と内腔への鋸歯状の突出(parietal cell protrusion:PCP)は1例(5.6%)でみられた.一方,非癌症例のうち14例で生検が実施され,腺管の嚢胞状拡張は8例(57.1%),PCPは7例(50.0%)でみられたが,腺腔内壊死物質は指摘できなかった.非癌群において,自己免疫性胃炎を2例,内視鏡的粘膜下層剥離術後瘢痕を2例,腺腫を1例,ランタン沈着を1例,胃MALTリンパ腫を1例に認めた.【結論】胃癌粘膜と非癌粘膜ではWGAの成因は異なり,非癌症例ではPPI服用が関与している可能性が示唆された.(著者抄録)

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その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00192&link_issn=&doc_id=20220125370003&doc_link_id=10.11280%2Fgee.64.29&url=https%3A%2F%2Fdoi.org%2F10.11280%2Fgee.64.29&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Enriched CD45RA⁻CD62L⁺ central memory T and decreased CD3⁺CD56⁺ natural killer T lymphocyte subsets in the rectum of ulcerative colitis patients

Masaya Iwamuro, Takahide Takahashi, Natsuki Watanabe, Takehiro Tanaka, Toshihiro Inokuchi, Sakiko Hiraoka, Fumio Otsuka, Hiroyuki Okada

International Journal of Immunopathology and Pharmacology 36 205873842110519 - 205873842110519 2022年1月

掲載種別：研究論文（学術雑誌）出版者・発行元：SAGE Publications

Objectives

To investigate the distinctive features of lymphocytes promoting inflammation in ulcerative colitis.

Methods

We performed flow cytometric analysis of peripheral blood mononuclear cells (PBMCs) and colorectal mucosa lymphocytes in ulcerative colitis patients ( n = 13) and control patients ( n = 5).

Results

CD62L⁺/CD3⁺CD4⁺ (35.7 ± 14.0% vs. 19.9 ± 6.4%) and CD62L⁺/CD3⁺CD4⁻ cells (17.1 ± 17.4% vs. 2.4 ± 3.9%) were higher in the rectum of ulcerative colitis patients than in control patients. Subpopulation analysis revealed that CD45RA⁻CD62L⁺/CD3⁺CD4⁺, that is, central memory T cell fraction in CD4⁺ T cells, was significantly increased in the rectum of ulcerative colitis, compared to that in control patients (23.3 ± 10.5% vs. 8.2 ± 4.0%). Comparison of rectum and colon samples in ulcerative colitis patients indicated that CD56⁺/CD3⁺ was decreased in the rectum compared to that in the colon (11.3 ± 12.5% vs. 21.3 ± 16.5%). The ratio of CD56⁺/CD3⁺ was also decreased in the rectum of active ulcerative colitis patients compared to that in ulcerative colitis patients at the endoscopic remission stages (2.8 ± 1.7% vs. 18.5 ± 13.3%).

Conclusion

We demonstrated that CD62L⁺ T lymphocytes, particularly the CD45RA⁻CD62L⁺ T cell subset that represents central memory T cells, were increased in the rectum of patients with ulcerative colitis. In addition, the CD56⁺/CD3⁺ subset (natural killer T cells) was decreased in the rectum compared to that of less inflamed colonic mucosa. These results suggest that the enrichment of central memory T lymphocytes and the reduction of natural killer T cells in the gut mucosa are involved in the pathogenesis of ulcerative colitis.

DOI： 10.1177/20587384211051982

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その他リンク： http://journals.sagepub.com/doi/full-xml/10.1177/20587384211051982

Helicobacter suis-Associated Gastritis Mimicking Conventional H. pylori-Associated Atrophic Gastritis. 査読国際誌

Masaya Iwamuro, Somay Yamagata Murayama, Masahiko Nakamura, Kenta Hamada, Takehiro Tanaka, Hiroyuki Okada

Case reports in gastrointestinal medicine 2022 4254605 - 4254605 2022年

担当区分：筆頭著者,　責任著者記述言語：英語

A 45-year-old Japanese man underwent esophagogastroduodenoscopy, which revealed spotty redness at the gastric fornix, mucosal swelling, diffuse redness in the corpus, and mucosal atrophy in the gastric angle and antrum. Histological examination showed rod-shaped bacteria that appeared larger than Helicobacter pylori. The patient tested positive for rapid urease test, and serum anti-H. pylori IgG antibody test results were negative. Further examination of the bacteria revealed that H. suis antibody test was positive, and the presence of H. suis was confirmed using H. suis-specific real-time PCR. H. suis was successfully eradicated after triple therapy with vonoprazan, amoxicillin, and clarithromycin. This case reinforces the notion that non-H. pylori Helicobacter species such as H. suis and H. heilmannii may be involved in the pathogenesis of active gastritis in patients who test negative for H. pylori antibodies.

DOI： 10.1155/2022/4254605

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[A case of Peutz-Jeghers syndrome that developed triple cancers during the course].

Keishi Fujiwara, Seiji Kawano, Tatsuhiro Yamazaki, Takeshi Tomoda, Masaya Iwamuro, Hironari Kato, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 ( 5 ) 446 - 451 2022年

記述言語：日本語掲載種別：研究論文（学術雑誌）

At the time of colon polyp follow-up, a 46-year-old Japanese woman with a history of invagination, colon polyps, cervical cancer, and breast cancer was suspected of Peutz-Jeghers syndrome and referred. Multiple polyposes of the jejunum were discovered by capsule endoscopy and double-balloon endoscopy, and the resected specimen was diagnosed with hamartoma. During the follow-up, advanced pancreatic cancer-derived from IPMN developed. It is important to remember that multiple cancers can develop in Peutz-Jeghers syndrome.

DOI： 10.11405/nisshoshi.119.446

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Zinc Acetate Dihydrate Tablet-associated Gastric Lesions. 査読

Masaya Iwamuro, Takehiro Tanaka, Sakiko Kuraoka, Kenta Hamada, Makoto Abe, Yoshiyasu Kono, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Internal medicine (Tokyo, Japan) 61 ( 13 ) 1931 - 1938 2022年

担当区分：筆頭著者,　責任著者記述言語：英語掲載種別：研究論文（学術雑誌）

Objective This study aimed to determine the prevalence and endoscopic features of zinc acetate dihydrate tablet-associated gastric lesions. Methods We retrospectively examined the endoscopic features of 47 patients taking zinc acetate dihydrate tablets who underwent esophagogastroduodenoscopy. Results Gastric mucosal alterations, including redness, erosions, ulcers, and adhesion of the white coat, were observed in 29 of 47 patients (61.7%). Among patients with gastric lesions (group A), there was a significantly higher percentage of symptomatic patients in comparison to patients without lesions (group B) (65.5% vs. 22.2%; p<0.01). The background characteristics of the two groups did not differ to a statistically significant extent. On esophagogastroduodenoscopy, mucosal redness (n=27, 93.1%), erosions (n=26, 90.0%), adhesion of the white coat (n=25, 86.2%), and ulcers (n=9, 31.0%) were observed. None of the 19 patients who previously underwent esophagogastroduodenoscopy had gastric lesions before starting zinc acetate dihydrate. Esophagogastroduodenoscopy was performed after the cessation of zinc acetate dihydrate intake in six patients, and revealed the resolution of gastric lesions. Conclusion Gastric lesions were observed in 29 of 47 patients who were taking zinc acetate dihydrate tablets. The most common endoscopic findings were mucosal redness (93.1%), erosions (90.0%), adhesion of the white coat (86.2%), and ulcers (31.0%). Although the exact pathogenesis is uncertain, we believe that understanding the unique manifestations of this gastric lesion will help physicians manage adverse events in patients taking zinc acetate dihydrate tablets.

DOI： 10.2169/internalmedicine.8625-21

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Zinc Acetate Dihydrate Tablet-Associated Gastritis Occurring in a Post-Hematopoietic Stem Cell Transplant Recipient. 国際誌

Masaya Iwamuro, Takehiro Tanaka, Akifumi Matsumura, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Case reports in gastrointestinal medicine 2022 4637707 - 4637707 2022年

記述言語：英語

A 65-year-old Japanese woman underwent umbilical cord blood transplantation for acute myeloid leukemia. Zinc acetate dihydrate tablets were administered for hypozincemia after transplantation, and vomiting and appetite loss occurred soon thereafter. Esophagogastroduodenoscopy revealed mucosal redness, erosion, white coat adhesion, and ulcers. Although graft-versus-host disease, intestinal transplant-associated microangiopathy, and cytomegalovirus infection were considered as possible causes, we diagnosed the patient with zinc acetate dihydrate tablet-associated gastric mucosal alterations based on the endoscopic features. This case reinforces the notion that medication-associated gastric lesions should be suspected in patients taking zinc acetate dihydrate tablets.

DOI： 10.1155/2022/4637707

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[Zinc acetate-associated gastric lesions:a case report].

Masaya Iwamuro, Yoshiyasu Kono, Takehiro Tanaka, Kenta Hamada, Hiromitsu Kanzaki, Seiji Kawano, Yoshiro Kawahara, Hiroyuki Okada

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 119 ( 9 ) 853 - 857 2022年

記述言語：日本語掲載種別：研究論文（学術雑誌）

An 82-year-old Japanese man underwent esophagogastroduodenoscopy for postprandial epigastric discomfort. The patient was diagnosed with hypozincemia with a serum zinc level of 63μg/dL (normal range:80-130μg/dL), and he had commenced oral intake of zinc acetate 1 month before the esophagogastroduodenoscopy. Endoscopy showed erosions with white-coated mucosa surface adhesions and erythema on the lesser curvature of the gastric body. Moderately differentiated tubular adenocarcinoma was suspected based on the biopsy examination findings;therefore, he was referred to our hospital for further examination and treatment. A repeat endoscopy showed two erosions with white-coated mucosa surface adhesion and erythema on the lesser curvature of the gastric body. However, the lesion location was different from that detected in the initial endoscopy. The biopsy showed no neoplastic changes. Therefore, based on the endoscopic findings and history of oral zinc acetate administration, we diagnosed the gastric mucosal injury as zinc acetate-associated gastric lesions. The cessation of zinc acetate intake resulted in the resolution of gastric lesions. Reassessment of the biopsy specimen from the initial endoscopy revealed erosions, epithelial cells showing infarct-like necrosis, degenerative atypical cells, and necrotic substances, which were misdiagnosed as neoplastic changes. This case highlights the importance of recognizing the typical endoscopic features of a zinc acetate-associated gastric lesion to enable its prompt diagnosis during esophagogastroduodenoscopy.

DOI： 10.11405/nisshoshi.119.853

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十二指腸に濾胞性リンパ腫、リンパ濾胞過形成、リンパ管腫およびリンパ管拡張を合併した1例

岩室雅也, 田中健大, 岡田裕之

岡山医学会雑誌 133 ( 3 ) 175 - 180 2021年12月

記述言語：日本語出版者・発行元：岡山医学会

70歳男性。健診の上部消化管内視鏡検査にて十二指腸病変を指摘され、当院へ紹介となった。精査の結果、十二指腸・空腸病変を伴うIV期の濾胞性リンパ腫と診断されたが、FLIPI2で中間リスクに分類され、また無症状でbulky病変がないため経過観察の方針となった。だが、14ヵ月後の拡大鏡を含めた内視鏡所見では十二指腸に濾胞性リンパ腫、リンパ濾胞過形成、リンパ管腫、リンパ管拡張の4種の白色病変が確認された。

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