虫垂開口部に発生したPeutz-Jeghers型ポリープの1例

Peutz-Jeghers Type Polyp Occurring in the Appendiceal Orifice, Report of a Case

要旨●患者は60歳代，女性．虫垂炎症状の既往があり，便潜血陽性にて大腸内視鏡検査を施行したところ，虫垂開口部に短い茎を有する2cm大の軟らかな隆起性病変を認めた．腫瘤の表面には，分葉の間の溝に厚い粘液が貯留しており，梅干し状と形容される特異な肉眼形態を示していた．拡大観察では，類円形，楕円形，星芒状の多彩なpitが観察され，腫瘍・非腫瘍の鑑別が困難な病変であった．組織学的には，樹枝状に分岐した粘膜筋板を軸に均一な分葉構造を示し，非腫瘍性の過形成性大腸腺管の増殖を認め，Peutz-Jeghers型ポリープの像であった．

　A 61-year-old female presented for evaluation with symptoms suggestive of appendicitis. A fecal occult blood test was positive, and a colonoscopy was performed, which revealed a 2cm flexible, elevated lesion with a short pedicle in the appendiceal orifice. The mass had a peculiar gross morphology, which may be described as a pickled plum shape, and thick mucus pooled within grooves between lobulations on the surface of the mass. Magnification of the mass revealed various types of pits, including ovals, ellipses, and stars. Differentiation between tumor and uninvolved tissue was difficult on endoscopic evaluation. Histological examination revealed a uniformly lobulated structure with the dendritically branched muscularis mucosa as an axis, and nonneoplastic, hyperplastic ductal gland growth into the large intestine. The overall image was consistent with a Peutz-Jeghers type polyp.