CASE REPORT H Sm: Idnn I H On Un Immunhhm Chkm Yhd nd Mk Tkuh Ab W db 56--d wmn wh h m nn h bn mw. Th np pd du nd hwd n hph. Immunhhm, h np w p CD68, zm, CD4 nd CD163, bu n B- nd T- mk, S1 pn nd ph mk. Th pn d mu-n hmhp nd n 22 mnh dn whu un. H m n xdn hmp npm nd h pn p du pd pn, wdpd d nd p pn hp. I mpn nz h npm nd nm h dn un p mmunhhm mk. K wd: h m, u mnn h, mmunhhm ndn, h/ mph-p nn (DOI: 1.2169/nnmdn.47.386 Indun H m, whh d u mnn h, n xdn hmp npm. Npm n d h mphm b Rppp h nmpd b hnu up dd (1. Own dn n mmunhhm nd mu b, h mj d h mphm, whh w ndd b npm h/mph n bd n h mph u, w u T- B- nn- Hdkn mphm pn h d wh mphm (2-4. Th n Wd Hh Onzn (WHO n p h n h np xud d nn m h hn h/mph, uh mphm nd h npm. W n nund h m wh dn w nmd b mmunhhm bn mw bp pmn. Th pn um pndd mu-n hmhp nudn pd wd b mbnn humn nu-n mun (hg-csf. Th pn n 22 mnh dn whu un. H, h mph nd mmunhhm u h npm dbd n d, nd dn dn dud. C Rp A 56--d wmn pnd u wh u nd pkn n Nmb 25. Ph xmnn hwd h h w b, p nd hd md hpm, bu n kn n, nu bnm mphdnph. H n ndn w p wh n En Cp On Gup pmn u 4. A mp bd un hwd uk un 1.8 1 9 /L wh 2% nu, 74% mph nd 24% mn, hmbn 6.4 /dl nd p un 11 1 9 /L. Sum bhm ud d mkd d dhdn (LDH 9,99 U/L (nm n: 12-24 U/L nd n 191,8 n/ml (nm n: 1-16 n/ml, w nd n dunn wh bubn 2.1 m/dl (nm n:.2-1. m/dl, p mnn 1,543 U/L (nm n: 1-35 U/L, nn mnn 445 U/L (nm n: 7-42 U/L, bd u nn 44 m/dl (nm n: 8-22 m/dl nd nn 2.47 m/dl Dn Hm, Nn Hp Onzn Mnm-Okm Md Cn, Okm Rd pubn Jun 15, 27; Apd pubn Ob 3, 27 Cpndn D. Chkm Yhd, hd@-km.hp..jp 165
DOI: 1.2169/nnmdn.47.386 F u 1. H p h u hb nm w b p p m n. ( AN p h dp dd u nd hn m h m p h u w d d( H m x n nde n n n, n m n n 1 BN p h d bund n n ph p m nd und nu ( H m x n nde n n n, n m n. ( CCD6 8( KP1 mmun h h m n n( n m n : h p m um w d u p CD6 8 n b d DL z m mmun h h m n n( n m n : h p m um w d u p z m n b d ECD1 6 3 mmun h h m n n( n m n : um w p CD1 6 3 n b d FS1 p n mmun h h m n n ( n m n : um w n S1 p n n b d. (nm n:.45-.8 m/dl. Cun hwd h h phmbn m w 13.7 nd, n nnn nmzd 1.44, bnn 116 m/dl nd bnn ddn pdu 48. m/l. Bd nd un uu w n. Th h X- w nm nd mpud mph h bdmn dmnd md hpm, bu n pnm mphdnph. A bn mw pn w pmd, bu n m mp w bnd whh hwd pn p. Th mph nd mmunhhm h h w nd n d un h bn mw bp pmn. Mph, h p hd bundn nph pm nd und nu, nd h w du pn h wh n hph (F. 1A nd 1B. Nm hmp w bn. Th p w n CD2/CD79 (B- mk, CD3 (T- mk, CD56 (NK mk, CD138 (pm mk, kn (mn nd ph mk nd ph mmbn nn (ph mk, bu p CD68 (KP-1/PG-M1: mph/h mk (F. 1C, zm (mph/ h mk (F. 1D nd CD4 (T- nd mph/h mk b mmunhhm. M, h w p h hh p mph/h mk, CD163 (F. 1E. Th 166
DOI: 1.2169/nnmdn.47.386 w n S1 pn (mn, Lnhn nd ndn dnd mk (F. 1F (Tb 1. Bd upn h u, dn h m (u mnn h wh dmnd nu un (DIC w md. Th u Tb1. ImmunhhmRu h Bn MwBpSpmn pm hn n n h nmn h mmunbun h hn nd T- p n n pn-mbddd u, whh d n nmn h n (d n hwn, uppd u dn. Mdd CHOEP-14 hmhp (phphmd 75 m/m 2 d 1, dxubn 5 m/m 2 d 1, nn 1.4 m/m 2 d 1, pd 1 m/m 2 d 1 nd pdnn 5 m/m 2 d 1-5 wd b hg-csf (m d 3 μ/d w dmnd mmd, nd nnu hpn w dmnd bu h DIC. Du h nd n dunn, h d phphmd w dud 75% h ndd d b nd dxubn w dud 25% h ndd d b dun h 2 u hmhp. A h dmnn h u CHOEP-14, h um bhm u nudn h LDH nd un nmzd nd h hpm mpd; hw, h pnpn pd nd du np w bd n h bn mw d 12. Th, nd u d-dud CHOEP-14 w dmnd. Th pnpn d d 1 h nd u, nd h bn mw pn d n np, w n hph. H n ndn nd b d mpd (F. 2. Sx ddn mdd CHOEP-14 (u-d d b w dmnd, nd h pn n 22 mnh dn whu un. Fu2. Cnudunh2uhmhp.A2mdd CHOEP-14,hpnpndwhhnmznhbd,ndhbn mwpndnnp. 167
DOI: 1.2169/nnmdn.47.386 Dun Th WHO n dnd h m mnn pn hwn mph nd mmunphnp u m h mu u h (5. Th dn h m pdmnn n h mph u h h n, nd h xun mphm nd h p dnd mnn (.. nm nd mnm b mmunhhm ud. In h, h bn mw w nd wh pn um, whh hd bundn nph pm nd und nu, nd hwd n hph. Th w p h mk, CD68 (KP-1 nd PG-M1, zm nd CD163, bu n B-, T/NK-, ph mk nd S1 pn. Th, w xudd mphm, nm nd mnm m h dn h. Bu h mbn n u, hmph ndm, whh pn h nd n d wh mphm n du, hud b dnd. In h, wh n hph w n, h bnm n h bn mw hd pd du nd dd h nm hmp m. Th ph ndn w dn m h hmph ndm. Fm h u, w b h h npm h h n. Th WHO n ddd h nd dnd npm n 6, uh h m, Lnhn h, Lnhn m, u dnd m/um, ndn dnd m/um nd dnd m n hw pd (6. P mmndd mmunnn CD68, zm, CD1, S1 pn, CD21 nd CD35 h dn dn h n (7. In h, h m xpd CD68 (n 1% h nd zm (n 96% h ; hw, h Lnhn mk (CD1 nd u dnd mk (CD21/35 w n, nd h S1 pn (p xpd n Lnhn um w bd (n 33% h. Hw, h hh ndn - h mmunhhm nbd n bd b p h pn du pbm. F xmp, KP-1 n md nd m p mnn mphm (8, wh PG-M1 n mk, m p nm nd mnm (9. Rn, CD163, hmbn n p (1, w hwn dn h wh hh d p, nd h bm pmn mk h dn h mnn (11, 12. In h, h np n h bn mw w p mup CD68 nbd uh KP-1 nd PG-M1, w zm nd CD163. Fn, w nudd h h dn h w h m. H m mmn pn xnd uh h bn mw,, pn nd nn; m, m hw m pnn, un h h h dn mnn h (1. Ahuh m h bn d wh mn m h ud mphm, h pn w p du pd pn, h pn wdpd d nd h p pn hp. P pd h mn h 12 d wh hmhp wh whu dhp, n 2 mnnd mp mn wh 7 dd d (7. Rn d h hwn pmn u wh h ddn pd nnn CHOP hmhp n mp mn nd n- u, nd h n dun m 3 2 wk un hg-csf (CHOEP-14 hd nn n u n pn un m mphm und 6 d (13. Th, w dmnd mdd CHOEP-14 h pn pn n ndn h n ndn. A u, h h d 22 mnh h dn whu un. I mpn nz h xdn npm nd nm dn un p mmunhhm mk, quk pb. Rn 1. Rppp H. Tum h hmp m. A Tum Ph. U.S. Amd F Inu Ph. Whnn, DC, 1966: 49-63. 2. Wn MS, W LM, G KC, Mn DY, Dmn RF, Wnk RA. Mnn h. A mn pu pd n 1975 bd n pn n mmunphnpn ud. Cn 66: 53-536, 199. 3. Ln EG, Hnn CA, Jzz W, Pn BA. Tu h mphm. Smn On 18: 39-49, 1991. 4. E RM, Shmz L, Snnd P, Mnn C, Nb ME. Mnn h: mn m d h npm nd w h u. Md Pd On 25: 1-7, 1995. 5. W LM, Gn TM, Mu-Hmnk HK,. H m. In: Wd Hh Onzn Cn Tumu: Ph nd Gn Tumu Hmp nd Lmphd Tu. J ES, H NL, Sn H,, Ed. IARC P, Ln, Fn, 21: 278-279. 6. J ES. H nd dnd npm. In: Wd Hh Onzn Cn Tumu: Ph nd Gn Tumu Hmp nd Lmphd Tu. J ES, H NL, Sn H,, Ed. IARC P, Ln, 21: 275-277. 7. P SA, Gn TM, H NL,. Tumu h nd dnd : n mmunhhm pph n m h Innn Lmphm Sud Gup bd n 61. Hph 41: 1-29, 22. 8. Cbn A, Ghn A, Vp R, Pn A. KP1 (CD68-p mphm: hph nd mmunphnp hzn 12. Hum Ph 24: 886-896, 1993. 168
DOI: 1.2169/nnmdn.47.386 9. Fn B, Fnh L, P S,. PG-M1: nw mnn nbd dd n x-n pp n h mph-d m h CD68 mu. Am J Ph 142: 1359-1372, 1993. 1. Knn M, Gn JH, Jbn C,. Idnn h hmbn n p. Nu 49: 198-21, 21. 11. Lu SK, Chu PG, W LM. CD163: p mk mph n pn-mbddd u mp. Am J Cn Ph 122: 794-81, 24. 12. Mkm M, Sdh Y, Suuu Y, Wd H, Suh T. Mn/Mph-p mk CD163+ h m: p wh n, mph, mmunhhm, nd mu n ud. In J Hm 8: 365-369, 24. 13. Pundhuh M, Tump L, K M,. Tw-wk 3- wk CHOP hmhp wh whu pd h mn un pn wh d-pn (nm LDH mphm: u h NHL-B1 h DSHNHL. Bd 14: 626-633, 24. 28 Th Jpn S Inn Mdn hp://www.nk..jp/mndx.hm 169