若年性大腸ポリポージスの1例

Juvenile Polyposis Coli, Report of a Case

　大腸ポリポージスには腫瘍性の大腸腺腫症，非腫瘍性のPeutz-Jeghers症候群，若年性ポリポージス，Cronkhite-Canada症候群などが知られている．これらの中で若年性ポリポージスは極めてまれな疾患であり欧米で50数例，本邦で8例が報告されているにすぎない．われわれは特異な組織学的型態を示し，家族性を認め，McColl¹⁰⁾，武藤ら¹²⁾の報告しているjuvenile polyposis coli，若年性大腸ポリポージスに該当すると考えられる症例を経験したので報告する．またこの症例は胃前庭部幽門部にも多発性ポリープが認められたことが特異的である．

　症　例

　患　者：24歳，女，事務員．

　現病歴：生来健康であった．1976年6月30日，下痢，下血にて当科外来へ．1976年7月10日，注腸X線検査にて大腸に多発性の分葉状，有茎性のポリープを認めた．1976年7月21日，内視鏡的に直腸，S状結腸のポリープ3個摘出．1976年7月26日，開腹し，計10個の結腸ポリープを摘出した．

　A 24 year-old woman was admitted to the First Department of Surgery of Gunma University, with a history of episodes of diarrhea and bloody stool. Radiological and endoscopical examination revealed multiple lobulated, pedunculated polyps in the large intestine. At the upper G. I. series multiple polyps were recognized in the antrum of the stomach, and the biopsy specimen presented histological feature of hyperplastic polyps. The polyps of the large intestine were distributed three in the rectum and sigmoid colon, seven in the cecum and the ascending colon, and three in the transverse colon. They were removed endoscopically and surgically. Histologically the polyps were composed of irregular branching and cystic dilated glands, and of the stoma which was edematous, having scanty vessels and connective tissue. Almost all of the glands were lined by non-atypical columnar epithelia, but a few glands were lined atypical epithelia similar to those of adenoma. From the above-mentioned findings, this case was confirmed as “juvenile polyposis coli” which was primarily described by McColl, and differed from P-J syndrome or C-C syndrome in both chemical and histological findings. McColl reported the familiar occurrence of this condition and the prevalent occurrence of colonic cancer in the same family. A patient with colonic cancer was family of this case. As multiple polyps were seen also in the stomach. We also regard this case as “generalized juvenile gastrointestinal polyposis” described by Schatello.