間質に異型細胞を伴った食道胃接合部ポリープ（polyp with stromal atypia）の1例

Inflammatory Esophagogastric Polyp with Stromal Atypia, Report of a Case

要旨　患者は54歳，約10年来の胸焼けと嘔気のため内視鏡検査を施行，SCJ 12時方向に約8mm大の立ち上がり明瞭なポリープを認めた．表面は光沢があり一部白色調粘膜と発赤の混在した隆起性病変で，口側には逆流性食道炎を伴っていた．X線検査では食道裂孔ヘルニアを伴う食道胃接合部に10×10mmの丈の低い隆起がみられ表面は比較的平滑な顆粒状を呈し，肛門側には胃側から連続する腫大した皺襞を伴っていた．生検病理組織所見ではポリープを覆う扁平上皮は肥厚し，粘膜固有層の間質に慢性炎症細胞浸潤と小血管の増生がみられ，一部には短紡錘形から楕円形の異型細胞が認められた．しかし病理学的に悪性所見は指摘されず，間質の反応性異型を伴う食道胃接合部（EGJ）ポリープと診断しプロトンポンプ阻害剤（PPI）による内服治療を行った．約1か月後の内視鏡検査ではポリープの縮小傾向となり経過観察中である．

　A 54-year-old patient underwent an endoscopic examination for heartburn of 10-years standing and vomiting. At 12 o'clock at the squamocolumnar junction (SCJ), an evident, raised polyp measuring about 8 mm was recognized. This lesion was covered with whitish mucosa partly tinged with redness and had a lustrous surface. Its oral side was marked by the presence of reflux esophagitis. An X-ray examination showed a slightly elevated lesion (measuring 10×10mm) with a relatively smooth, granular surface at the esophagogastric junction that was characterized by an esophageal hiatal hernia. And the lesion was also accompanied by a swollen gastric fold. Histopathological examination of the biopsy specimen showed a chronically mildly inflamed esophageal mucosa with hyperplastic squamous epithelium and a proliferation of small vessels at the stroma of the lamina propria. Atypical cells-short spindle cells and ovoid cells-were also noted in parts. However no pathological malignancy was detected. A diagnosis of a polyp of the esophagogastric junction (EGJ) with reactive atypia of the stroma was made. The patient was treated with an oral proton pump inhibitor (PPI). An endoscopic examination conducted about a month later indicated that the polyp appeared to have been reduced in size. The patient is currently under observation.