食道胃接合部にみられた食道pseudoepitheliomatoushyperplasiaの1例

Pseudoepitheliomatous Hyperplasia of the Esophago-Gastric Junction, Report of a Case

要旨　症例は37歳，男性．人間ドックの胃X線検査で噴門部に異常を指摘．上部消化管内視鏡検査では食道胃接合部小彎に多結節状の乳頭状隆起とそれに接して口側に伸びる発赤調の陥凹を認めた．逆流性食道炎と食道ポリープとして経過観察していたが，陥凹部からの生検で異型扁平上皮が認められたためEMRを施行．病理組織学的には隆起部分は上皮の下方への増生が著しく，pseudoepitheliomatous hyperplasiaと診断した．さらに隆起部と陥凹部は，(1)脚釘の延長，(2)顆粒球浸潤を伴った粘膜固有層の肉芽形成，(3)基底細胞の核は腫大しているが極性は保たれている，などの共通所見を有し逆流性食道炎に伴うcomplex lesionと考えた．特徴的な肉眼所見および組織所見を有する本疾患の認識は癌との鑑別上重要である．

　A 37-year-old man was referred to our hospital for further examination of a polypoid lesion of the esophago-gastric junction detected during screening by upper GI endoscopy. The first endoscopic examination revealed a nipple-shaped polypoid lesion at the lesser curvature of the esophago-gastric junction. The lesion continued to a reddish longitudinal shallow depression in the esophagus on its oral side. We diagnosed these lesions as reflux esophagitis and hyperplastic polyp of the esophagus. The patient was followed-up for 8 months. The second endoscopy showed no remarkable change in macroscopic appearance. However, histologic finding of the biopsy specimen taken from the depression indicated atypical squamous epithelium. Endoscopic mucosal resection was performed. Histopathology showed pseudoepitheliomatous hyperplasia of the esophagus. For diagnosis, it is important to be able to differentiate this disease and its macroscopic appearance from esophageal carcinoma.