内視鏡的に切除した空腸孤在性Peutz-Jeghers型ポリープの1例

An Endoscopically Resected Solitary Peutz-Jeghers Polyp of the Jejunum, Report of a Case

要旨　患者は64歳，女性．1994年に回腸の狭窄性病変を指摘され回腸部分切除術を受けたところ，非乾酪性肉芽腫を認めた．その後，回腸末端部の狭窄と大腸のアフタ様病変が出現しCrohn病と確診された．1995年7月に経過観察のため施行した小腸X線検査で，上部空腸に頭部が小結節状を呈する有茎性隆起を認めた．Push式小腸内視鏡下にポリペクトミーを施行したところ，Peutz-Jeghers型ポリープと診断された．家族歴や皮膚症状に欠如し，単発性であったことから孤在性Peutz-Jeghers型ポリープと考えられた．

　A 64-year-old woman with a prior history of partial ileal resection for Crohn's disease was admitted to our institution, complaining of diarrhea. She was negative for medical and family histories of mucocutaneous pigmentation and gastrointestinal polyps. Colonoscopy revealed small ulcers in the terminal ileum. Double-contrast radiography of the small intestine showed a pedunculated polyp in the jejunum. Push-type enteroscopy revealed the lesion to be a pedunculated polyp. The polyp was resected by endoscopic polypectomy. Histologic examination of the resected specimen revealed that the lesion consisted of branching bundles of smooth muscle fibers covered with slightly hyperplastic epithelium. We diagnosed this case as a solitary Peutz-Jeghers polyp of the jejunum.