Cronkhite-Canada症候群の2例―とくにポリポージスの組織所見について

Two Cases with Cronkhite-Canada's Syndrome: With special reference to histologic changes in polyposis

　われわれは，胃，小腸，大腸にわたる広範なポリポージス，皮膚の色素沈着，脱毛，爪甲の萎縮，低蛋白血症があり，遺伝歴のない2症例を経験したので報告する．本症例は，1955年にCronkhiteおよびCanada¹⁾が，generalized gastrointestinal polyposis with pigmentation, alopetia and onychotrophiaとして報告し，1966年にJarnumら²⁾がCronkhite-Canada症候群として考察を加えたものと同一と思われるので，ここに症例を述べて考察を加えたいと思う．

症例

　〔症例1〕57歳，女，織物工員

　家族歴，既往歴に特記すべきものはない．

　Two cases with Cronkhite-Canada's syndrome are described in this paper.

　Case 1: A 57-year-old woman was admitted to the hospital complaining of both atrophy and falling-off of nails, diarrhea and loss of weight. Serum proteins were 5.8 gr. per 100 ml, with Gordon's test 4.6 per cent. The amount of fecal fat was 10.4 gr. per 24 hours. Except for the esophagus, roentgenogram revealed multiple polyps all through the digestive tract. Endoscopy also demonstrated numerous hemispheric polyps in the stomach, duodenum and colon. Laparotomy was performed under a diagnosis of polyposis of the digestive tract, and the terminal ileum was excised about 10 cm long. Changes observed by histology were distinct cystic dilatation of the glands, cellular infiltration, enlarged, edematous stroma and dilatation of lymph vessels in the submucosa.

　Case 2: A man aged 57, who had undergone gastrectomy 13 years before on account of peptic ulcer, was hospitalized, complaining of severe diarrhea of four months' duration, increasing pigmentation on hands and feet, falling-out of hair and atrophy of nails. Serum proteins were 3.6 gr. per 100 ml, Gordon's test being 2.7 per cent. The amount of fecal fat was 18.1 gr. per 24 hours. x-ray examination revealed multiple, disseminated polyps in the gastric remnant, small intestine and colon. Those in the gastric stump and colon were demonstrated by endoscopy as well. Biopsy of the colon showed changes such as enlarged, edematous stroma and cellular infiltration, although cystic dilatation of glands were not so remarkable. In addition, dilated serpentine vessels were pictured by lymphography.

　Histologic picture in this case showed in typical parts meager atypicality of glandular epithelia, cystic dilatation of glands, hypersecretion of mucus, enlarged, edematous stroma and cellular infiltration, all resembling those characteristics as are seen in juvenile polyp of the colon. Abnormal observations in the lymph vessels were thought closely rerated with the mechanism with which protein is lost into the digestive tract.