内視鏡的粘膜下層剝離術を施行した高異型度肛門上皮内腫瘍および肛門部尖圭コンジローマ併存例の1例

Coexisting High-grade Anal Intraepithelial Neoplasia and Condyloma Acuminatum Treated with Endoscopic Submucosal Dissection, Report of a Case

要旨●患者は80歳代，女性．近医にて便潜血陽性を指摘され大腸内視鏡検査を施行．直腸肛門部病変を指摘されたため当院へ紹介された．精査にて直腸肛門部に径約20mmの白色調の扁平隆起性病変を認めた．インジゴカルミン撒布像にて境界明瞭な扁平隆起・細顆粒状隆起を呈した．NBI観察で同部位はbrownish areaとして認識され，NBI拡大観察ではドット状血管，ループ状血管，糸くず状の血管の増生が認められた．診断的治療としてESDを施行した．病理組織学的に高異型度肛門上皮内腫瘍と尖圭コンジローマが併存した腫瘍であった．免疫組織化学染色にてp16の過剰発現が認められ，HPV（human papilloma virus）との関連が強く示唆された．

　A woman in her 80s underwent colonoscopic examination after a positive fecal occult blood test. Colonoscopy revealed a flat elevated whitish lesion, measuring approximately 20mm, located in the anal canal. We clearly confirmed the margin of this lesion using indigo carmine dye. Narrow-band imaging without magnification demonstrated this lesion as brownish and elevated ; magnifying colonoscopy with narrow-band imaging revealed loop-like and meandering microvessels resembling the intraepithelial papillary capillary loops observed in early-stage squamous esophageal carcinoma. We performed ESD（endoscopic submucosal dissection）for en bloc resection of the lesion. The lesion was pathologically diagnosed as an anal（squamous）intraepithelial neoplasia, low and high grade, with condyloma acuminatum. Immunostaining for p16 was strongly positive. These findings suggest that the tumor was strongly associated with oncogenic human papilloma virus infection.