cap polyposis―臨床像と治療経過

Cap Polyposis: Clinical Features and Courses

要旨　4例のcap polyposisを経験した．年齢には幅があったが，全例女性だった．初発症状は3例が下痢，血便，1例が便秘だった．内視鏡的初期像として斑状発赤を認めた．診断時の検査成績としては，高度の低蛋白血症と炎症所見を伴わないことが特徴であった．病変の主体は直腸～S状結腸であり，白苔を伴った暗赤色の無茎～亜有茎ポリープの多発からなる症例と，発赤陥凹を伴った地図状，類円形の扁平隆起と周囲に白斑を認める症例に分けられた．組織学的にはともに腺管の延長，ねじれ，拡張，粘膜層の炎症細胞浸潤，表層の慢性肉芽組織を特徴としていた．1例は排便習慣の改善，1例はステロイド注腸が著効した．他の2例には人工肛門を造設，1例はそれによりポリープはほぼ消失したが，もう1例はすぐに再燃し，腸管切除を余儀なくされた．

　We have encountered four cases with cap polyposis. They consisted of 4 women of mixed ages. Three patients had diarrhea and bloody stools at onset time and the other one had constipation.

　The endoscopic view at onset time was spots of redness with edema. characteristic laboratory data were hypoproteinemia due to protein losing enteropathy and no abnormal inflammatory parameters. Main lesions were in the area from the rectum to the sigmoid colon, and presented two endoscopic findings, namely, multiple dark-red sessile～semipedunculated polyps covered with fiblinopurulent cap and flat elevations with red depression surrounded with white plaques. Histological findings of both polyps showed elongated, tortuous and distended glands and inflammatory infiltration of cells covered by a ‘cap’ of inflammatory granulation tissue. One patient was cured successfully by avoidance of straining during defecation. Another one showed good response to steroid enema. Another one had recurrence after double-barreled transverse colostomy. The remaining one had a good response to loop ileostomy, but she had severe relapse after catching a common cold, and total proctocolectomy had to be performed.