食道胃接合部に発生した乳頭腫の2例

Papilloma on the Esophagogastric Junction, Report of Two Cases

要旨　食道胃接合部に発生した食道乳頭腫の2例を報告した．〔症例1〕は48歳，男性．主訴は上腹部不快感．上部消化管X線検査で胃入口部にポリープを指摘された．内視鏡検査では，食道胃接合部に約1cmの粗大顆粒状の亜有茎性ポリープを認め，表面は赤色調の部と不整形の白色調の部が混在していた．ヨード染色では，大部分が不染を示していた．生検時の組織像では，ポリープの一部には炎症細胞を伴う肉芽組織があり，その中に大型の異型細胞が散見され，食道扁平上皮癌が疑われた．内視鏡的ポリペクトミーによる病理組織学的診断は，びらんを伴う乳頭腫であり，pseudomalignant erosion（PE）を伴った乳頭腫と考えられた．〔症例2〕は65歳，女性．検診胃X線検査で胃入口部のポリープが指摘された．内視鏡検査では，食道胃接合部に約8mmの粗大顆粒状の亜有茎性ポリープを認めた．ヨード染色では濃染を示していた．内視鏡的ポリペクトミーによる組織診断は比較的定型的な乳頭腫の組織像であった．胃接合部における乳頭腫は生理的慢性刺激を受けやすく，PEの合併を考慮した診断が必要である．また，生検標本では組織量が十分でなく，異型細胞の組織分布や浸潤性の判定には内視鏡的ポリペクトミーが診断に有用と思われた．

　Two cases of a papilloma on the esophagogastric junction were reported. The 〔case 1〕was 48-year-old man with a complaint of upper abdominal discomfort. Upper gastrointestinal (GI) X-ray examination showed a polyp on the entrance of the stomach. Upper GI endoscopic examination disclosed a rough granular surfaced and semipedunculated polyp, 1 cm in size, whose surface was mixed with red portions and whitish irregular portions. Iodine staining showed most surface of the polyp was unstained. Microscopic examination of the biopsy specimen showed a granulomatous lesion with inflammatory cells, in which large atypical cells were found, therefore, squamous cell carcinoma of the esophagus was suspected at that time. Pathohistological examination of the endoscopically polypectomized specimen showed a papilloma with erosion, which led to a diagnosis of papilloma with pseudomalignant erosion (PE). The 〔case 2〕was 65-year-old woman. Upper GI screening examination showed a polyp in the entrance of the stomach. Upper GI endoscopic examination disclosed a rough granular-surfaced semipedunculated polyp, about 8 mm in size, which was strongly positive for iodine staining. Microscopic examination of the endoscopically polypectomized specimen showed rather typical histological findings of the papilloma. The papilloma on the esophagogastric junction is subjected to chronic mechanical stimulation; therefore diagnosis should be carefully made in consideration of PE. The biopsy specimen is not big enough to judge distribution of atypical cells and invasivity, so endoscopic polypectomy is appropriate in that sence.