若年性胃腸管ポリポーシスの1例

Gastrointestinal Juvenile Polyposis, Report of a Case

要旨　患者は39歳，男性で，胃部不快感を主訴に受診．X線，内視鏡検査で胃角部から幽門部にポリポーシスを認め，前庭部前壁では大きな結節状隆起を呈していた．組織学的に若年性ポリポーシスが疑われた．大腸にも十数個のポリープを認めた．胃切除術および大腸は内視鏡的ポリペクトミーを施行した．組織学的には胃，大腸とも若年性ポリポーシスで，胃の大きな隆起部分では若年性ポリープ中に胃型の異型上皮様構造と，一部に明らかな胃型の腺癌を認めた．大腸のポリープは若年性ポリープと腺腫，癌の併存を認め，腺腫内癌はなかった．若年性胃腸管ポリポーシスはまれな疾患で，癌化の問題，家族内の消化管癌の発生の危険性を中心に文献的考察を行った．

　A 39-year-old man visited our hospital because of epigastric discomfort. Upper gastrointestinal series and endoscopic examination revealed numerous small polyps from the gastric angle to the pylorus and a large polypoid tumor at the antrum. At the same time seven-teen polyps were found in the colon and rectum. Examination of the biopsy specimen led us suspect juvenile polyposis. Partial gastrectomy was performed for the gastric polyposis. All polyps of the colon and rectum were also removed endoscopically. Examination of the resected specimen of the stomach showed numerous small polyps from the angle to the pylorus and a large polypoid tumor with nodular surface. These numerous small polyps were histologically compatible with juvenile polyposis. The large polypoid tumor, on the other hand, had foveolar type atypical epithelium and adenocarcinoma in the upper part of the lesion, while components of juvenile polyp was also found in the lower part of the lesion. The seventeen polyps removed from the colon and rectum included 10 juvenile polyps, 2 juvenile polyps with adenoma (moderately atypia), 4 juvenile polyps with adenocarcinoma, and 2 lesions of adenocarcinoma without components of juvenile polyps. Juvenile polyp with carcinoma in adenoma was not found.