過誤腫性ポリポーシスの拡大観察

Magnified Endoscopcic Findings of Hamartomatous Polyposis with Special Reference to Peutz-Jeghers Syndrome

要旨　過誤腫性ポリポーシスの拡大内視鏡所見を中心に概説した．Peutz-Jeghers症候群では，胃ポリープは，類円形から楕円形に拡張した腺管が比較的均一に配列している．大腸ポリープでは，類円形，楕円形，星芒状，樹枝状pitを呈し，配列も不均一で多様性を認めた．また，背景粘膜にも腺管の拡張や配列異常を認めた．若年性ポリポーシスは，やや大型の円形腺管や星芒状腺管など腺管構造の異常を認めた．Cowden病は，食道の白色扁平ポリポーシスが特徴的で，胃や大腸ポリープでは，類円形・スリット状・樹枝状など様々な形態の異常腺管を認めた．過誤腫性ポリポーシスは悪性腫瘍合併のリスクが伴い，このような拡大内視鏡をも併用した消化管検査に加え，他臓器癌のサーベイランスが重要である．

　We studied magnified endoscopic findings of hamartomatous polyposis. In Peutz-Jehgers syndrome, gastric polyps exhibited round and/or oval pit pattern with regular arrangement. Colonic polyps exhibited various pit patterns including round, oval, stellar and/or branched pits with irregular arrangement. In the background mucosa, slight dilatation of pits and their irregularity in arrangement were seen. In juvenile polyposis, large round or stellar pits were identified on magnifying endoscopy. In Cowden disease, gastrointestinal polyps exhibited diverse pit patterns such as round, slit and branched pits. In cases of hamartomatous polyposis, these pit patterns are of clinical importance throughout surveillance not only for gastrointestinal cancer but also for malignancies in other organs.