小腸血管腫の1例

Hemangioma of the Small Intestine, Report of a Case

要旨　患者は42歳の女性．30歳時にタール便で輸血を受け，今回再びタール便があり輸血の後に当院へ紹介された．入院時血色素8．8g/dlの貧血を認めたが，上部および下部消化管内視鏡検査では異常なく，小腸X線で骨盤内の小腸に約10cm長の粘膜下腫瘍を認め，CTで同部に7cm大の低吸収域とその一部の石灰化を認めた．血管造影では異常なし．以上の所見から小腸血管腫を疑い，手術を施行した．小腸のほぼ中央に異常血管の集簇を認め，小腸部分切除術を施行した．術中小腸内視鏡では結節状の隆起性病変を認め，切除標本の割面では凝血塊を入れた大小多数の囊胞状構造を認めた．組織学的には内皮細胞に裏打ちされた管腔構造の集まり，で，免疫組織化学染色で抗第VIII因子抗体，抗CD34抗体および抗smooth muscle actin（SMA）抗体に陽性であった．以上から小腸血管腫と診断した．出血を伴った小腸リンパ管腫との鑑別を考察した．

　A 42-year-old woman with a history of tarry stool and blood transfusion was admitted to our hospital because of recurrent tarry stool requiring blood transfusion. Hemoglobin at admission was 8.8 g/dl. No abnormalities were detected by upper and lower endoscopy, but x-rav examination of the small intestine showed a submucosal tumor 10 cm in size. CT showed a low density mass with calcification. No abnormality was shown by angiography. Under suspicion of hemangioma of the small intestine, an operation was performed and partial resection of the small intestine was carried out. Endoscopy during operation revealed multiple nodular elevated lesions. Macroscopically, a bluish multi-nodular mass measuring 12×9 cm could be seen from the small intestine to the mesentery. Cut surfaces of the resected specimen showed multiple cystic structures containing coagula. Histological examination disclosed an accumulation of luminal structures lined by endothelial cells. Immunohistochemical study showed positive for antifactor VIII stain, anti-CD34 stain anti anti-smooth muscle actin stain. Relying on these data, a diagnosis of hemangioma of the small intestine was made. Differential diagnosis from bleeding lymphangioma was discussed.