胃検診を契機に診断されたCowden病の1例

Cowden's Disease, Report of a Case

要旨　患者は40歳，男性．35歳時に扁桃摘出術．祖母は胃癌で死亡．1998年6月，胃検診にて胃ポリポーシスを指摘され来院．消化管精査にて食道全域にびまん性にglycogenic acanthosisと同様の白色小隆起を認め，胃は前庭部を中心に大小不同の隆起が密在しており，体部小彎にも拡がっていた．直腸，S状結腸には数mm大の，周囲と同色調または発赤調でⅠ型pit patternを示すⅠsからⅠsp型隆起が多発していた．組織学的にはいずれも異型上皮は認めず，以上の特徴的な消化管所見よりCowden病と診断した．また顔面の小丘疹などの皮膚所見のほか，本症例は著明な甲状腺腫大も認め，吸引細胞診にてclass Ⅲと診断された．

　A 40-year-old man visited our hospital because he was diagnosed as having gastric polyposis by mass examination with Barium meal radiography of the stomach. He had struma and small papules were on his face. Colonoscopic finding showed polyposis from the rectum to the sigmoid colon. After crystal violet staining, these polyps showed type Ⅰ pit pattern on Kudo's classification. The histological diagnosis was hyperplastic polyps. The endoscopic findings of the stomach showed numerous polyps without specific findings and these polyps were histologically diagnosed as chronic gastritis. The endoscopic findings of the esophagus showed diffuse whitish papules and these lesions were clearly stained by Iodine staining, which finding is in accordance with glycogenic acanthosis. Histological findings showed epithelial hyperplasia without dysplasia. Through these endoscopic and histological findings, this patient was diagnosed as having Cowden disease by finding. The CT of the cervix thyroid tumor and aspiration biopsy showed atypical cell suggesting cystic malignant goiter. The pit pattern diagnosis is significant for differential diagnosis of gastrointestinal polyposis, especially with non-specific histoligical findings like Cowden's disease.