著明な貧血を呈し術前に診断しえた小腸リンパ管腫の1例

Lymphangioma of the Small Intestine, Report of a Case

要旨　患者は31歳，女性．繰り返す著明な鉄欠乏性貧血による全身倦怠感を主訴に近医受診，便潜血反応陽性のため消化管出血が疑われたが，上部および下部消化管内視鏡検査で異常を認めず，精査加療目的にて当院に紹介入院となった．小腸X線検査で上部空腸に約3cm大の柔らかい結節状隆起性病変を認めた．小腸内視鏡検査では，表面に微細顆粒状の白色斑および赤色斑を伴う，黄色調の柔らかい分葉状粘膜下腫瘍であった．生検にて粘膜内のリンパ管拡張所見を認め，小腸リンパ管腫と診断し，小腸部分切除術を施行した．病理組織学的には粘膜下層および粘膜固有層は，1層の薄い内皮に被われた大小の管腔から成り，内部は好酸性のリンパ液に満たされていた．一部に出血を伴っており，出血を伴った小腸リンパ管腫と診断した．小腸リンパ管腫の内視鏡所見は特徴的で，術前診断に有用であり，文献的考察を加えて報告する．

　A 31-year-old woman was admitted to our hospital because of severe anemia. Radiography of the small intestine revealed a sharply defined filling defect measuring 35×30mm in size in the upper part of the jejunum. Endoscopy of the small intestine showed a submucosal tumor, which had a yellowish surface with red and white specks, located in the upper jejunum. A biopsy specimen from the lesion revealed dilated lymphatic vessels in the mucosa. On the basis of these findings, the tumor was diagnosed as a lymphangioma and thus was resected by operation. The surgical specimen showed a soft, lobulated lesion (measuring 35×29×10mm) and the cut surface revealed tiny multicystic spaces. The pathological findings showed dilated lymphatic vessels containing eosinophilic homogeneous fluid mixed with red blood cells in both the mucosa and submucosa, and it was finally diagnosed as lymphangioma accompanied with bleeding into the lymphatic vessels. Such characteristic endoscopic features of lymphangioma of the small intestine may play an important role for diagnosis.

　1) Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

　2) Department of Internal Medicine, Saiseikai Fukuoka General Hospital, Fukuoka, Japan