内視鏡的切除を施行した空腸inflammatory fibroid polypの1例

Inflammatory Fibroid Polyp of the Jejunum Treated by Endoscopic Resection, Report of a Case

要旨　患者は38歳，女性．黒色便と息切れを主訴に当院入院．小腸造影ではTreitz靱帯のすぐ肛門側の空腸に亜有茎性の比較的太い基部を有する隆起性病変を認めた．腹部超音波，CTでは左上腹部に約2cmの類円形の腫瘤を認めた．細径大腸ファイバースコープを経口的に挿入した内視鏡検査では光沢のある赤色調で，いわゆる亀頭様の隆起性病変を認めた．留置スネアを併用し内視鏡的切除を施行した．病理組織学的には炎症細胞の浸潤と線維芽細胞や膠原線維の増生を認め，inflammatory fibroid polyp（IFP）に矛盾しない所見であった．自験例は小腸IFPを内視鏡的に診断，治療しえた本邦初の症例である．

　A 38-year-old woman was admitted to our hospital with black stool and a floating sensation. X-ray examination showed a semipedunculate polypoid lesion in the jejunum, just to the anal side of the Treitz' ligament. Ultrasound and computed tomography demonstrated a mass lesion in the left upper abdomen. Endoscopy revealed a semipedunculate polypoid lesion with a reddish surface in the jejunum. We resected the tumor endoscopically using a detachable snare. The tumor was histopathologically diagnosed as inflammatory fibroid polyp (IFP), with infiltration of inflammatory cells and proliferation of myofibroblasts, collagen fiber, and blood vessels in the submucosal layer. Seven months after endoscopic resection, X-ray examination showed no polypoid lesion but an ulcer scar in the jejunum. We describe the first case of small intestinal IFP in Japan diagnosed and treated by endoscopic resection.