食道切除後の残存食道に発生したpyogenic granulomaの1例

Esophageal Pyogenic Granuloma after Esophagectomy, Report of a Case

要旨　食道切除後の残存食道にpyogenic granulomaが発生した症例を経験した．患者は60歳，男性．1998年，食道癌に対して食道切除胃管再建術が施行されている．主訴は摂食時のつかえ感．手術後は定期的に内視鏡検査を行っていた．2005年7月には逆流性食道炎のみを認めたが2006年7月には吻合部直上に5mm大の表面平滑な隆起性病変が出現した．2007年2月には長径約10mm大に増大し生検では血管腫の診断であった．腫瘤増大・通過障害がみられ，癌との鑑別も必要なため同年3月に内視鏡的切除を施行した．切除時に病変はさらに増大し表面が発赤調となり白苔付着を認めた．標本は12mm大で病理組織学的に毛細血管の増生を伴う肉芽組織の形成を認めpyogenic granulomaと診断した．

　A 60-year-old man complained of dysphagia. He had undergone esophagectomy for esophageal carcinoma in 1998. Follow-up endoscopy and CT scanning were performed at regular intervals after the operation. Endoscopic examination only revealed reflux esophagitis in July, 2005, but a smooth elevated lesion with a diameter of 5mm was detected in the remnant esophagus in July, 2006. The lesion had increased in diameter to 10mm and become polypoid by February, 2007. Biopsy of the lesion showed hemangioma, and endoscopic polypectomy was performed in March, 2007.

　Pathological examination revealed granulation tissue in the stroma with proliferation of dilated capillaries, so the lesion was diagnosed as pyogenic granuloma.