びらん性全消化管ポリポーシス（erosive gastro-intestinal polyposis）の1例―新しい疾病?

A Case of Erosive Gastro-Intestinal Polyposis: a New Entity ?

要旨　胃体下部から直腸までの消化管と虫垂に千個以上の隆起性病変を形成した1症例を報告した．（1）本症例の病変の主体は6mm以下の半球状隆起で中心陥凹を伴い，胃のタコイボ型びらん類似の形態を示した．これらのびらんは白苔の付着がある活動期の病変，白苔の付着がない治癒期の病変など様々であった．（2）半球状隆起の他に大きさ1～2mmの小平坦隆起や0.5mm前後の微小環状発赤などの病変も認められた．（3）いずれの病変も病理学的には限局性の炎症性細胞浸潤，腺窩上皮の過形成，リンパ濾胞の過形成，再生上皮，微小血管の増生，などから成り，種々の大きさや時期のびらんによって形成された病変と解釈された．（4）以上の所見から，本症例はerosive gastro-intestinal polyposisと呼称するのがよいと考えた．なお，PubMedと医中誌で調べた限りでは同様の症例は見い出せなかった．

　We report a case with extensive polyposis（more than 1,000 elevated lesions）from the stomach to the rectum. The clinicopathological findings were as follows :

　1. The main morphological characteristics of the lesions were small semispherical elevated lesions with central depression, which were measured at less than 6mm. These characteristics were similar to those of chronic erosive gastritis, namely, so called“erosive gastritis verrucosa”. The elevated lesions were accompanied with various stage of erosive change, that is, active stage with mucosal break/inflammatory exudate and inactive stage with healed mucosa.

　2. The rest of the lesions composed of minute flat elevated lesions measured at 1 to 2 mm in diameter, minute ring-shaped reddened mucosa and minute semispherical elevated lesions.

　3. The histopathological findings demonstrated that the polypoid lesions comprised hyperplastic/regenerative foveolar epithelium with focal inflammatory infiltrate, hyperplasia of lymphoid follicle, and proliferation of microvessels in the lamina propria mucosa. These findings seem to be compatible with gastrointestinal chronic focal erosive pathologies.

　As far as we know, these clinical and pathological findings have not yet been reported. Accordingly, we make a proposal of a new entity named“Erosive gastro-intestinal polyposis”.