大腸マラコプラキアの1例

Malakoplakia of the Colon and Rectum, Report of a Case

要旨　患者は79歳，男性．主訴は1日数行の下痢と，体重減少．注腸X線検査では，直腸からS状結腸に径5～6mmの小結節隆起の散在と，横行結腸中部から肝彎曲，上行結腸，盲腸に同様の小結節隆起と，皺襞の集中を伴うびらんを認めた．大腸内視鏡検査で直腸からS状結腸および，横行結腸中部から盲腸まで，円形から楕円形の黄白色調で光沢のない表面顆粒状の，丈の低い小結節病変の散在，皺襞集中，粘膜の萎縮を認めた．各部位の生検材料の病理組織学的検索では，上皮に異型性を認めず，間質にマクロファージの浸潤があり，その胞体内にはMichaelis-Gutmann bodyを有しており，ハンゼマン（Hansemann）細胞と同定された．以上から本例をまれな慢性炎症性疾患である大腸マラコプラキアと診断した．

　A 79-year-old man had suffered from diarrhea several times a day and body weight loss. He was referred to our hospital for a close examination of the colon in October, 1994. Barium enema and colonoscopic examinations revealed multiple white-yellowish nodular lesions, erosion with fold convergence and atrophic mucosa concomitantly in the colon and rectum. Histopathological examination of the resected specimen by rectal strip biopsy showed histiocytes infiltrating into the mucosa and the submucosa, with sheet layer formation or aggregates. The histiocytes contained typical cytoplasmic inclusions known as Michaelis-Gutmann bodies, which are characteristic of malakoplakia. This case was diagnoed as malakoplakia of the colon and rectum, which is a very rare chronic inflammatory disease.