大腸癌と乳癌を併発した若年性胃腸管ポリポーシスの1例

Generalized Juvenile Gastrointestinal Polyposis Complicated with Colon Cancer and Breast Cancer, Report of a Case

要旨　患者は51歳，女性．貧血，下口唇粘膜の白色小腫瘤，体幹部皮膚に疣贅状色素沈着を認め，当科にて消化管の検索を行ったところ，主として胃体部全域に無茎性，数mm大の小ポリープの密生を認めた．直腸・結腸にはIs～Ip，米粒大～約3cmのポリープを計7個，散在性に認めた．胃と大腸のポリープはすべて若年性ポリープの組織像を呈した．このうち，結腸肝彎曲部の約3cmのポリープには若年性ポリープと高分化型腺癌（sm癌）の併存を認めた．更に右乳房に乳癌の合併が認められた．大腸ポリープはすべてポリペクトミーされ，その後，結腸部分切除術，右乳房切除術が施行された．手術から3年後に乳癌による肝転移，骨転移を来し死亡した．本例のように若年性胃腸管ポリポーシスに疣贅状色素沈着，口腔内乳頭腫様病変，大腸癌，乳癌を合併した報告はなく，特異な例と考えられた．本邦報告の若年性ポリポーシス43例の検討も併せて行った．

　A 51-year-old female who had anemia, multiple verruciform pigmentations in her trunk and papillomatous lesions in her lower lip mucosa was referred to our department in order to examine the cause of anemia. Roentgenographic and endoscopic examinations revealed numerous small polyps in the body of the stomach and seven polyps in the large intestine. The histological examinations of the polyps showed characteristic features of juvenile polyp. In one of colonic polyps which measured about 3 cm in diameter, well differentiated adenocarcinoma (submucosal invasion) and juvenile polyp hamartoma coexisted. Moreover, she had right breast cancer (papillotubular adenocarcinoma). This patient is considered to be the first case in juvenile polyposis, with the complications of breast cancer, body pigmentation and papillomatous lesion in the oral cavity. It should be stressed that patients with juvenile polyposis should undergo cancer surveillance not only of the gastrointestinal tract but also of other organs.