盲腸に発生した神経節細胞腫の1例

Ganglioneuroma of the Cecum, Report of a Case

要旨●患者は50歳代，男性．便潜血反応陽性のため大腸内視鏡を施行した．盲腸に表面平滑な隆起性病変を認めた．色素撒布像で隆起の周辺に無名溝が消失した領域があり，その境界は不明瞭であった．NBI拡大観察で隆起頂部には深部から表層に向かって走行する拡張・蛇行した血管が観察された．クリスタルバイオレット染色像で同部位はI型pitが観察され，窩間部は開大しており，上皮下腫瘍と考えられた．確定診断を目的としてprecutting EMRを施行した．病理組織学的には主に粘膜固有層内に紡錘形細胞が増殖し，またその中に神経節細胞の混在もみられ，神経節細胞腫と診断された．上皮下腫瘍の形態を呈した神経節細胞腫の1例を経験したので，その内視鏡検査所見を検討し，報告する．

　A 50-year-old man came to our hospital with purpose of examination for positive fecal occult blood test. Colonoscopy revealed a smooth-surfaced, protruding lesion in the cecum. After spraying the indigocarmine dye, the border of the lesion was obscured. Magnifying endoscopy by narrow-band imaging technique revealed dilated and tortuous microvessels on the surface of the lesion. After spraying the crystal violet dye, a non-neoplastic pit was detected on the lesion and intervening part was dilated. These findings suggested that this lesion was a subepithelial tumor. Diagnostic endoscopic mucosal resection was performed and histological examination revealed spindle and ganglion cells in the lamina propria. Therefore, a diagnosis of ganglioneuroma was made.