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Stomach and Intestine(Tokyo) Volume 54, Issue 7 （June 2019）

胃と腸 54巻7号（2019年6月発行）

Japanese English

早期胃癌研究会症例

腫瘍性病変との鑑別を要した直腸粘膜脱症候群の1例 Elevated Lesions of Mucosal Prolapse Syndrome Observed Using Magnifying Endoscopy, Report of a Case 荻原久美 ¹ , 大仁田賢 ² , 宿輪三郎 ³ , 丸山祐二 ⁴ , 福田英一郎 ⁵ , 山口直之 ¹ , 野々下政昭 ⁶ , 井関充及 ⁷ , 新野大介 ⁸ , 中尾一彦 ¹ Kumi Ogihara ¹ , Ken Ohnita ² , Saburo Shikuwa ³ , Yuji Maruyama ⁴ , Eiichiro Fukuda ⁵ , Naoyuki Yamaguchi ¹ , Masaaki Nonoshita ⁶ , Masachika Iseki ⁷ , Daisuke Niino ⁸ , Kazuhiko Nakao ¹ ¹長崎大学病院消化器内科 ²春回会井上病院消化器内科 ³長崎北徳洲会病院消化器内科 ⁴朝倉市医師会病院内科 ⁵福田内科胃腸科 ⁶佐世保共済病院放射線科 ⁷佐世保共済病院病理診断科 ⁸長崎大学病院長崎病理医育成・診断センター ¹Department of Gastroenterology and Hepatology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan ²Department of Gastroenterology, Inoue Hospital, Nagasaki, Japan ³Department of Gastroenterology, Nagasakikita Tokushukai Hospital, Nagasaki, Japan ⁴Department of Internal Medicine, Aasakura Medical Association Hospital, Asakura, Japan ⁵Fukuda Naika Ichouka, Sasebo, Japan ⁶Department of Radiology, Sasebo Kyosai Hospital, Sasebo, Japan ⁷Department of Pathology, Sasebo Kyosai Hospital, Sasebo, Japan ⁸Nagasaki Educational and Diagnostic Center of Pathology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan キーワード：直腸粘膜脱症候群 , fibromuscular obliteration , LST , 拡大内視鏡所見 Keyword: 直腸粘膜脱症候群 , fibromuscular obliteration , LST , 拡大内視鏡所見 pp.1063-1069

発行日 2019年6月25日 Published Date 2019/6/25

DOI https://doi.org/10.11477/mf.1403201791

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要旨●患者は40歳代，男性．主訴はなく，生来健康で既往歴は特に認めなかった．健診目的に大腸内視鏡検査を施行したところ，直腸下部（Rb領域）に20mm大の隆起性病変を認めた．病変の境界は比較的明瞭でLST（laterally spreading tumor）様の形態を示しており，拡大観察では楕円形，直線型の多彩なpitが観察され，腫瘍性病変・非腫瘍性病変の鑑別を要する病変であった．病変部からの生検では，線維筋症（fibromuscular obliteration）を認め，直腸粘膜脱症候群の像を示していた．

　A 40-year-old male without any significant medical history visited the hospital for colon cancer screening. The patient had no gastrointestinal symptoms, such as diarrhea, constipation, bloody stool, or abdominal pain. Physical examination and clinical laboratory evaluations resulted in no significant findings. Colonoscopy revealed a flat, elevated lesion in the rectum. The lesion was red in color and appeared to be a tumor spreading laterally. Dilated, round, and partially linear pits were observed in the lesion using magnifying endoscopy with crystal violet staining. The pits gradually resolved to a normal appearance at the margins of the lesion.

　Biopsy examination showed no signs of malignancy, and fibromuscular obliteration was observed in the lamina propria. These findings are consistent with MPS（mucosal prolapse syndrome）. This patient did not require treatment because he was asymptomatic.

　MPS is a benign disease mainly caused by the habit of straining during bowel movements and rectal mucosal prolapse. It is categorized into three subtypes：flat, ulcerative, and polypoid. It is histologically characterized by fibromuscular obliteration of the lamina propria. This condition is relatively common but presents with various patterns. Importantly, MPS can be misdiagnosed as a malignant tumor. The current case was examined with magnifying endoscopy, and we were able to diagnose benign MPS instead of a malignant tumor.