lymphoid follicular proctitis（LFP）として経過観察している難治性直腸リンパ濾胞増殖性病変の1例

Refractory Rectal Lymphoid Follicular Hyperplasia Progressing to Lymphoid Follicular Proctitis, Report of a Case

要旨●初診時より5年以上にわたり経過観察している直腸リンパ濾胞増殖性病変を認める症例を経験した．患者は20歳代，女性．主訴は粘血便．頂部にびらんを伴う3〜5mm大の多発する半隆起性病変を直腸に限局して認めた．クラミジア直腸炎を疑い加療するも改善は認めなかった．病理結果からは悪性リンパ腫も否定的であった．5-ASA，ステロイド坐薬投与でも症状の改善はみられなかった．定期的に経過観察しているが，現時点でも内視鏡的・病理学的に潰瘍性大腸炎の診断には至らず，lymphoid follicular proctitis（LFP）と診断し経過観察中である．

　A 26-year-old woman was referred to our hospital for treatment of rectal lymphoid follicular hyperplasia. She complained of intermittent mucus and blood in stools without diarrhea. Colonoscopy revealed a circumferential, uniform rectal mucosa of granular appearance without mucosal ulceration. Histological examination of rectal biopsy specimens demonstrated the presence of lymphoid follicles, hyperplasia, and infiltration of lymphocytes within the mucosal lamina propria. There was no evidence of crypt hyperplasia, atrophy, abscesses, granulomas, ulceration, neutrophilic infiltrates, or impaired mucus secretion. Lymphoid follicular proctitis was diagnosed. Initially, a conservative approach to management was taken because of the absence of symptom exacerbation. On developing mucoid stools and hematochezia, mesalazine and batamethasone suppository treatment were initiated without improvement in symptoms and endoscopic findings. The patient was followed-up for more than 5 years, and she did not develop ulcerative proctitis or other inflammatory disease. This case highlights the importance of ascertaining or ruling out potential diseases when diagnosing and managing lymphoid follicular proctitis.