腺癌を合併した胃限局性若年性ポリポーシスの1例

Juvenile Gastric Polyposis with Adenocarcinoma, Report of a Case

要旨　患者は65歳女性．45歳時に胃ポリポーシスを指摘され他院で胃部分切除を受けた．10年後残胃に多発ポリープの再発を認め，一部をポリペクトミーし，その組織学的診断は若年性ポリープであった．その後，毎年当科で経過観察したが，2年前から鉄欠乏性貧血，蛋白漏出性胃腸症に基づく低蛋白血症を来し，ポリープの巨大化，貧血の進行を認めた．胃以外の消化管にはポリープは認めず，また，家族歴にも特記すべき異常はなかった．胃全摘術を施行し，病理学的に検討した結果，若年性ポリポーシスの一部粘膜内に中分化と高分化の腺癌を認めた．本例のような胃に限局した若年性ポリポーシス症例は極めてまれであり，長期間経過観察できた症例の報告はない．癌の合併と共に疾患概念に関して文献的考察を行った．

　A 65-year-old female patient who had been followed up for 10 years with gastric polyposis was admitted to our hospital. Family history was negative for any gastrointestinal disease. She had undergone partial gastrectomy for gastric polyposis in 1966. Ten years after the operation, she again developed polyps and was referred to our hospital for polypectomy. After polypectomy, she was followed up every year. The polyps increased in number and size, and laboratory data revealed iron deficiency anemia and hypoproteinemia due to protein losing gastropathy. She underwent total gastrectomy. Histological examination of the resected stomach showed characteristic features of juvenile polyposis, and extremely well to moderately differentiated adenocarcinoma was found in the mucosa. This patient is considered to be the second case in which juvenile polyposis involved the stomach alone.