空腸Peutz-Jeghers型ポリープの1例

Peutz-Jeghers Type Polyp in the Jejunum, Report of a Case

要旨　患者は25歳，女性．食後に増強する上腹部痛を主訴に当科を受診した．3か月後，痛みの頻度が増したため精査目的に入院した．入院時，左上腹部に4横指大の腫瘤を触知した．腹部超音波検査では同部の腸管にtarget signを認めた，小腸X線造影検査では，空腸重積の所見と表面が小結節状から顆粒状の有茎性病変を認めた．術中小腸内視鏡検査では周囲粘膜と同色調で表面が小結節状から穎粒状の有茎性病変がみられた．空腸部分切除標本では，頭部が33×30×25mmの有茎性病変を認めた．病理組織学的検索ではPeutz-Jeghers型ポリープと診断された．遺伝素因と色素沈着所見を欠いていたため最終的に空腸Peutz-Jeghers型ポリープと診断した．

　A 25-year-old female visited our outpatient clinic, complaining of intermittent upper abdominal pain increasing especially after meal intake. Three months later, the patient was admitted to our hospital because bouts of the pain had become more frequent. A mobile tumor was palpated in the left upper abdomen on admission. Abdominal sonographic study showed a target sign in the small intestine. The roentogenography with contrast media of the small intestine revealed a pedunculated tumor with nodular and granular surface, accompanied with local dilatation of the jejunum caused by obstruction. The endoscopic views during the surgical operation also disclosed a pedunculated tumor with nodularity and granularity, showing the same color as the surrounding mucosa. The tumor had neither erosion nor ulceration on its surface. Partial jejunectomy was performed. The resected tumor measured 33×30×25 mm in size. The pathological diagnosis of the tumor was Peutz-Jeghers type polyp. Finally, the patient was diagnosed as a case of jejunal Peutz-Jeghers type polyp because of the lack of any hereditary factor and the abnormal mucocutaneus pigmentation.