食道胃接合部に発生したpyogenic granulomaの1例

Pyogenic Granuloma of the Esophagus Located at the EGJ, Report of a Case

要旨●患者は70歳代，男性．喉のつかえ感を主訴にEGDを施行し，食道胃接合部に10mm大の頂部に白苔を有する発赤調の隆起性病変を認め，診断的治療目的にESDにて一括切除した．病理組織学的には表層上皮は剝離し，びらんを形成する部分や，菲薄化した扁平上皮が被覆する部分を認め，粘膜固有層には毛細血管の著明な増生，リンパ球や形質細胞などの炎症細胞浸潤，浮腫がみられ，一部線維化も伴っており，最終病理診断はpyogenic granulomaであった．内視鏡所見では，白苔を有する部分，白濁した領域に血管拡張が散見される部分，強発赤領域に拡張した血管が目立つ部分を認め，これらは時相の異なる病理組織学的所見を反映していたものと考えられた．

　A male in his 70s undergoing conventional esophagoscopy due to dysphagia was found to have a 10-mm reddish elevated lesion covered with a whitish coating on the top. The lesion was treated by endoscopic submucosal dissection with en bloc resection as a total biopsy. The pathological findings revealed erosions consisting of epithelium exfoliates or thin squamous epithelium on the surface of the lesion. The subepithelial proliferation of dilated capillary vessels, inflammatory cell infiltration, and edema in the stroma with fibrotic change were also recognized in the lamina propria. Consequently, this lesion was finally diagnosed as pyogenic granuloma. Endoscopic images, including magnifying endoscopy with narrow-band imaging, for this lesion showed various findings, such as a part covered with a thick whitish coat, a part with some dilated vessels in the cloudy region, and a part with strong redness showing many dilated vessels. The histopathological features of pyogenic granuloma are different based on the time phase. Moreover, these pathological differences may reflect the various endoscopic findings.