胃に多発性ポリープが発見された家族性大腸ポリープ症の1例

A Case of Familial Polyposis of the Colon Associated with Multiple Polyps of the Stomach

　家族性大腸ポリープ症は大腸に限局して無数に腺腫性ポリープが発生する疾患として知られているが，上部消化管の病変については意外に知られていない．私共は家族性大腸ポリープ症の家系の一員で大腸ポリポージスの外に胃にも多発性ポリープが観察されたので報告しこの問題について考察した．

症例

　22歳（1949年生れ）の女性．（No. 8931）．主訴，腹痛ならびに家族に大腸ポリープ症の患者がある為に精査を希望して来院した．

　The patient is a 22-year-old female of a family in which familial polyposis of the colon has been found in ten of them. Her younger brother had died of liver cancer at the age of seven. Her father had underwent total colectomy when he was 37 years old because of the polyposis. The polyposis was also confirmed in two of his siblings. Her grandfather on her father's side had once a diagnosis of it. Furthermore, not only her grandfather's brother and his child, but also a sister of her grandfather's had died of either polyposis or cancer of the colon.

　Present history : Since two years ago she had epigastrial pain when she was either tired or hungry. She also noticed at times mild bloody stool.

　The course of the present illness : Not only typical multiple polyps were demonstrated throughout the entire colon by barium enema examination, but what was most outstanding in this case was x-ray pictures of the stomach, where fairly uniform multiple polyps of round shape the size of a Indian bean at most were found localized in the corpus. Gastrofibescope revealed also in the fornix hemispheric mucosal protrusions here and there. Gastric biopsy was not successful. Gastric juice showed hyperchlorhydria.

　After having cauterized polyps of the rectum we have performed subtotal colectomy followed by cecorectal anastomosis. Some 700 sessile polyps the size of a soya bean at the largest were seen in the resected colon. Histologically, they were adenomas with no trace of malignancy.

　The patient was examined by romanoscope periodically after the operation, with repeated cauterization of remaining polyps. After 6 months they have mostly vanished. X-ray examinations of the stomach done at the same time disclosed that gastric polyps found before the operation remarkably reduced in number as was also confirmed by fiberscope.

　Relatively seldom has been the description of gastric polyps in the literature of familial polyposis of the colon up to now, but according as the examination methods of the stomach progress concomitant gastric lesions may be detected in future in a higher incidence.