Adenoma, juvenile polypに併発した直腸～S状結腸malakoplakiaの1例

Marakoplakia of the Sigmoid and Rectum, Report of a Case and Endoscopic Follow-up

要旨　約1年来，排便ごとに便に鮮血が付着することを主訴とした75歳女性（農業）に，直腸およびS状結腸下部に多発する小型丘状，一部に中央陥凹を有する2～8mm程度の白色～黄色浮腫状・易出血性の結節隆起病変を認めた．病理診断にて，非特異型の慢性炎症で，消化管にはまれなmalakoplakiaとされた．また大腸（上行・横行・下行・S状結腸・直腸）に散在した有茎性・亜有茎性の6個のtubular adenomaとS状結腸に1個のjuvenile polypを認め，内視鏡的ポリープ切除を施行した．臨床経過上，比較的良好な経過を示し，結節隆起は漸次減少し，1年半後には消失し症状も改善した．3年8か月の今日まで再発をみず，2年11か月間にsalazopyrin 1.5g/日を投与した．

　A case of rectosigmoid malakoplakia is presented and a follow-up of endoscopic pictures are shown from the stage of multiple nodules to pseudo-polypoids and then to atrophic mucosa without polypoid lesions. A 75 year-old woman visited our clinic in February 1983 and was admitted to our hospital complaining of bloody stools. This symptom had persisted for two years. She had no special previous history nor general diseases except blood hypertension. Total colonoscopy revealed edematous friable multiple nodules, many of which had a dip in the center, at the level of 3～15cm from the anus (Fig. 2) and several pedunculated polyps (ascending, transverse, descending and Sigmoid) which were polypectomized on several occasions.

　Histologically, the sigmoid one was a juvenile polyp (Fig. 3 c, d) and all the other polyps were tubular adenoma with structural atypia ranging from severe to moderate (Fig. 3 a, b). Rectosigmoid polypoid lesions were diagnosed as malakoplakia in November 1983 (Fig. 6). Clinically, her symptom ceased gradually by the end of 1983. Also the findings of endoscopy showed the number of polypoid lesions had decreased leaning only scattered protruding polypoid lesions. The last polypoid disappered in September 1984 (Fig. 5) and then the mucosa became atrophic without malakoplakia. This was shown by biopsy strudy. Salazopyrin 1.5g/day had been given for two years 11 months. She is well, and there are no findings of recurrence at the present time.