残胃に発生したhamartomatous inverted polypの1例

Hamartomatous Inverted Polyp of the Remnant Stomach, Report of a Case

要旨　患者は68歳の男性で，28年前に胃潰瘍で幽門側胃切除術を受けた．数年前から食欲低下があり，受診時には全身倦怠感と体重減少および貧血を認めた．胃X線検査では，残胃の小彎後壁側に太い茎部があり，巨大な脳回状の頭部は体位によって残胃から十二指腸へ逸脱した．内視鏡検査では巨大な茸状の有茎性ポリープがみられ，頭部には光沢のある粗大顆粒状の粘膜と，数か所に小潰瘍を認めた．開腹術を行い，腫瘤（頭部7×6cm，茎部幅3.5cm）を摘出した．組織学的には，大小の腺管が粘膜下層において増殖し，嚢胞状拡張が随所に観察された．腺管の主体は腺窩類似の上皮細胞であったが，一部に異型腺管も認められた．問質には線維性結合織の増生と平滑筋束がみられた．本病変は一種のheterotopiaであるが，病変の大きさと形態を考慮して，有茎性に発育したhamartomatous inverted polypと診断した．

　A 68-year-old man was admitted to our hospital in August of 1994 with a history of several years of anorexia and weight loss. He had undergone partial gastrectomy because of an intractable gastric ulcer in 1966. There was no family history of gastrointestinal or pigmentary disorder. Laboratory data on admission revealed an iron deficiency anemia and positive fecal occult blood. Upper gastrointestinal series and endoscopic examination showed a large pedunculated polyp in the remnant stomach which was prolapsed into the proximal duodenum. Surgical polypectomy was performed and the resected specimen was a soft polypoid tumor, measuring 7×6 cm at the head of the polyp. Histologic examination revealed a proliferation of foveolar glands with cystic dilatation in the submucosal layer. The stroma consisted of loose fibrous connective tissue and smooth muscle bundles. These pathologic findings were considered compatible with a hamartomatous inverted polyp.