内視鏡的に切除しえた小児の単発性胃ポリープの1例

Gastric Polyp in a Child with Successful Endoscopic Polypectomy, Report of a Case: Pathogenetic consideration and a review of Japanese literature

　単発胃ポリープの報告は，一般には高齢者のものがほとんどであり，わが国における14歳以下の小児症例は，われわれの集計では9例をみるにすぎない．これらの報告には，詳細にわたるものはなく，その病態についても不明な点が多い．

　近年，内視鏡の進歩により，小児における内視鏡検査は比較的容易となり，その適応も積極的に考慮されるようになってきている．われわれは貧血を主訴とした8歳女児に胃内視鏡検査を施行したところ，巨大な有茎性の単発性胃ポリープを認め，内視鏡的ポリペクトミーにより切除し，組織学的に検討したので文献的考察を加えて報告する．

　An eight-year-old girl was admitted to our hospital because of anemia. Deficient serum iron and hypochromic anemia had been present for two years and iron was given with some improvement. But repeated stool tests were positive for occult blood and anemia could not be eradicated. Her aunt received a polypectomy for solitary juvenile polyp of the rectum at the age of 28.

　X-ray examination revealed a large polyp in the first portion of the duodenum with a long stalk originating from the lower gastric body. The large and small intestines were not remarkable roentgenographically. Fiberscopic gastroscopy was performed with GIF-P2 (Olympus, Tokyo) under the topical anesthesia and demonstrated a large pedunculated mass passing through the pyloric canal. The head of polyp was lobulated with erosions and hemorrhage at its surface. Endoscopic polypectomy was performed and a mass measuring 45×40×20 mm was recovered. Histologically, crypts were elongated and dilated with a mixture of gastric glands beneath. The lamina propria was markedly vascular often showing angiomatous proliferation of capillaries. Postoperative course was uneventful and the patient is well 18 months after the procedure without anemia.

　So far nine cases of the isolated gastric polyp of childhood have been reported in Japan. Endoscopic polypectomy was performed in one. Hematemesis, anemia and obstruction due to duodenal prolapse were frequent presenting symptoms.

　This condition is also characterized by a relatively large size and histological features of hyperplastic polyp in an angiomatous stroma.