内視鏡的切除を行った空腸hamartomatous inverted polypの1例

Hamartomatous Inverted Polyp of the Jejunum Treated by Endoscopic Polypectomy, Report of a Case

要旨　患者は33歳，女性で，タール便で来院し正球性貧血を呈した．消化管の検索で空腸に有茎性の表面平滑で頂部がやや崩れた形の隆起性病変を認めた（15×8mm）．他の消化管に病変を認めず，この病変が出血の原因と考え，内視鏡的切除を行った．病理組織学的には，異型のない腺窩上皮が隆起の頂部で反転し，隆起内部へもぐり込んで腺管の過形成と囊胞状拡張を来していた．粘膜筋板は保たれており，上記変化は粘膜固有層のレベルで起こっていた．その形態学的特徴から本症の名称をhamartomatous inverted polypとした．本症は極めてまれな貴重な症例であり，文献的考察を加え報告する．

　A 33-year-old previously healthy female came to our hospital complaining of tarry stool. Laboratory data revealed normocytic, normochromic anemia and positive fecal occult blood. Investigation of the gastrointestinal tract showed a polypoid lesion in the upper jejunum but no other particular lesions. For this reason we considered it as the source of the gastrointestinal bleeding and anemia.

　Endoscopic polypectomy was performed successfully and the resected specimen was semipedunculated with a smooth mucosal surface, measuring 15×8 mm.

　Pathologically it consisted of inverted growth of foveolar glands above the muscularis mucosa. Hyperplasia and dilation of the intestinal glands without glandular atypia could be seen throughout the whole specimen.

　We considered this rare lesion as a hamartomatous inverted polyp.