カプセル内視鏡が診断に有用な疾患―小腸多発腫瘍─悪性リンパ腫を含む

Clinical Usefulness of Capsule Endoscopy in Patients with Multiple Small Intestinal Tumors

要旨　小腸多発腫瘍の精査目的で，カプセル内視鏡（CE）を実施した43例のCE所見を遡及的に検討した．腸管濾胞性リンパ腫の小腸病変は，空腸を中心に多発する区域性の白色絨毛ないし白色小隆起の集簇が特徴的であり，高度な十二指腸病変を有する症例で，小腸病変が多発する傾向が強かった．家族性大腸腺腫症では，十二指腸腺腫陽性例のみで空腸に褪色ないし白色調の隆起病変が確認された．また，Peutz-Jeghers症候群では多発性の発赤調有茎性ポリープ，Cowden病では伸長したリンパ濾胞過形成様隆起と暗青色調の血管腫様病変，多発神経内分泌腫瘍では黄白色調の粘膜下腫瘍様隆起を確認しえた．CEは小腸多発腫瘍の検出に有用であるが，本検査の臨床的意義については，さらなる検討が必要と思われた．

　We reviewed 43 patients, who underwent CE（capsule endoscopy）for the investigation of multiple small intestinal tumors. Multifocal mucosal lesions with whitish villi and diminutive protrusions in the jejunum seemed to be characteristic of small intestinal follicular lymphoma. In addition, patients with severe duodenal involvement tended to have multiple small intestinal mucosal lesions of follicular lymphoma. In patients with familial adenomatous polyposis, whitish jejunal protrusions were identified only in patients having duodenal adenomas. CE also identified multiple reddish pedunculated polyps in patients with Peutz-Jeghers syndrome, elongated hamartomatous polyps and hemangiomas in patients with Cowden's disease, and yellowish protrusions with occasional central depression on top in a patient with multiple neuroendocrine tumors, respectively. Further investigations seem necessary to clarify the clinical implications of CE in patients with multiple small intestinal tumors.