胆囊ポリポージスを合併した家族性大腸ポリポージスの1例

Familial Polyposis Coli Associated with Gallbladder Polyps, Report of a Case

　家族性大腸ポリポージス（familial polyposis coli 以下FPCと略す）に，胆囊ポリポージスを合併した1例を経験したので報告する．大腸は肝彎曲部で癌化しており，胆囊にみられた約30個のポリープも，その2/3に癌化（carcinoma in situ）を認めた．両者の合併例の報告はまだない．

　A case of familial polyposis coli with polyps in the gallbladder is presented. No previous description of this finding has been reported.

　A 76 year-old woman was admitted in December 1981 with a history of melena. Barium enema study revealed polyposis coli with advanced carcinoma of the colon. Preoperative ultrasonic study for screening liver metastasis disclosed polyps in the gallbladder. In January 1982 laparotomy was performed with subtotal colectomy and cholecystectomy. The resected colon showed about 300 polyps with advanced carcinoma on the hepatic flexure. Microscopic examination of the colon showed superficial adenocarcinoma in two of the largest polyps of the sigmoid colon. Gallbladder contained 30 polyps but no stones. Microscopic findings of the gallbladder polyps were very interesting. The four largest pedunculated polyps (7～12 mm in diameter) were carcinoma in the entire polyp without infiltration to the stalk. Fourteen polyps pedunculated or sessile (2～7 mm in diameter) showed superficial carcinoma in a part of adenomatous polyp. Ten polyps sessile (under 2 mm in diameter) were adenomatous polyps. They showed various degree of atypia similar to the colon polyposis. Hereditary tendency was proven to exist in colon polyposis but not in the gallbladder lesions.

　Polyposis coli has been described in combination with a number of other lesions but never with gallbladder polyps. Only one case of combination with carcinoma in situ of the gallbladder was previously reported. I believe ultrasonic study is very available for cases of polyposis coli.