微小癌が併存し内反性発育した孤在性十二指腸Peutz-Jeghers型ポリープの1例

An Inverted Growing Peutz-Jeghers type Polyp on the Duodenum with a Micro-intramucosal Adenocarcinoma, Report of a Case

要旨●患者は50歳代，男性．201X年に，咽頭癌の精査加療の際に上部消化管内視鏡検査（EGD）を施行したところ，十二指腸乳頭の肛門側に径30mmほどの類円形の陥凹病変を認めた．陥凹内には多彩な形態の粘膜隆起が複雑に入り組んでいた．2年後にEGDを施行し，生検で微小腺癌の併存を疑った．病変部から多量の出血を認めたため，内視鏡的止血術を施行した．開腹下で局所切除を施行し，微小癌を併存する内反性発育した孤在性十二指腸Peutz-Jeghers型ポリープ（PJP）と診断した．十二指腸のPJPは有茎性・亜有茎性の隆起を呈することが多いとされるが，有茎性以外の病変でもPJPに特徴的とされる脳回状，絨毛状の表面性状を認めた場合にはPJPを鑑別に挙げる必要がある．

　A man in his 50s was referred to our department for further investigation of pharyngeal cancer. EGD（Esophagogastroduodenoscopy）revealed a depressed lesion on the anal side of the duodenal papilla, with an approximate diameter of 30mm and including a complicated, convoluted mucosal lesion. Two years later, EGD revealed a growing mucosal lesion with a small reddish depressed region within the lesion. A biopsy of this region suggested adenocarcinoma. Three months later, massive bleeding occurred in this lesion, and hemostasis was achieved using a clip via endoscopy. Localized endoscopy-assisted resection of the duodenal lesion was performed. Pathological investigation of the resected tissue revealed an inverted growing PJP（Peutz-Jeghers type polyp）with two micro-intramucosal adenocarcinomas. PJP often has a stalk in the lesion on morphological examination. Our case indicates that PJP should be suspected when a convolute or villous surface pattern is noted, even if the lesion does not have a stalk.