長大な有茎性ポリープの形態を呈した回盲弁lipohyperplasiaの1例

Endoscopic Resection of Giant Pedunculated Lipohyperplasia of the Ileocecal Valve, Report of a Case

要旨　患者は，73歳，男性．特に自覚症状はなかったが，検診で便潜血陽性を指摘されたため，2004年2月大腸内視鏡検査を受けた．その際，回盲弁から上行結腸肝彎曲部付近まで，長く伸びた舌状の軟らかいポリープを認めた．大腸X線検査では，回盲部に基部を有する最長で130×35mmの有茎性病変として描出された．超音波内視鏡検査では，粘膜下にhyper echoic areaを認めた．拡大色素内視鏡で観察し，小腸・大腸粘膜の境界を確認しつつ，内視鏡的に切除した．組織学的に病変部はほぼ正常の大腸粘膜で被覆されており，頭部側の粘膜下層内には脂肪組織が増生していた．明らかな被膜の形成は認められず，lipohyperplasiaと診断した．

　A 73-year-old man underwent colonoscopy because of a positive reaction on fecal occult blood test. He was not obese and presented with no complaints. Colonoscopy revealed a long pedunculated polyp with wrinkles in the ascending colon. The polyp, attached to the ileocecal valve, was covered with the appearance of normal mucosa including slight erythema. Double-contrast radiography demonstrated a giant pedunculated polyp, measuring 130mm in maximal length and 35mm in width. The polyp showed marked elasticity and its length changed from 100mm to 130mm. We suspected it was a benign polyp and the polyp was resected by endoscopy. Microscopic appearance of the resected specimen demonstrated two components of mature adipose tissue and marked edematous change in the submucosa covered with normal mucosa. The adipose tissue was not encapsulated. The resected polyp was diagnosed as a lipohyperplasia.