特異な形態を呈した空腸脂肪腫の1例

Submucosal Lipoma of the Jejunum, With a Peculiar Morphology, Report of a Case

要旨　患者は63歳，男性．主訴は上腹部痛．タール便も認めたため近医に精査目的に入院，上・下部消化管内視鏡検査にて明らかな異常を認めず経口小腸X線検査にて，空腸に径20mm程度の有茎性ポリープを指摘され，当科入院となった．ゾンデ法小腸X線検査では，空腸に径30mm大の亜有茎性隆起性病変を認めた．表面性状は基部は平滑だが，頭部は粗大結節状で，基部に複数の太いひだの集中を伴っていた．小腸内視鏡検査を試みるも病変まで到達しなかった．小腸病変が消化管出血の原因と考え手術を施行した．術中内視鏡にて頭部に上皮欠損を伴う粘膜下腫瘍様隆起を認めた．病理組織学的には成熟した脂肪細胞より成る脂肪腫で，頭部にびらんを伴っていた．

　The patient was a 63-year-old man. His chief complaint was abdominal pain. He was admitted to the hospital because he noticed tarry stool. Neither panendoscopy nor colonoscopy disclosed any abnormalities, but radiography of the small intestine showed a semi-pedunculated tumor. The base of the tumor had a smooth surface, but the head revealed a rough, nodular appearance. Convergence of several folds towards the base of the tumor was observed. We thought this lesion was the cause of his symptom, so an operation was performed. Histopathological examination of the tumor, measuring 30×15mm, showed mature adipose tissue in the submucosa, which was covered by erosive and hyperplastic jejunal mucosa. The diagnosis of this case was difficult because of the peculiar morphology of this tumor.

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

Fukuoka, Japan