残胃の若年性胃ポリープに早期癌を合併した若年性胃腸管ポリポージスの1例

Generalized Gastrointestinal Juvenile Polyposis with an Early Cancer within a Juvenile Polyp in the Remnant Stomach

要旨　若年性胃腸管ポリポージスは，胃，小腸，大腸に多数の若年性ポリープを発生する遺伝性疾患であり本邦で3例，欧米で19例が報告されている．本症例は，65歳男性で11年前に胃潰瘍に対して胃切除を受けたが，その残胃に若年性ポリープを母地として発生したと考えられる早期癌と多数の若年性ポリープが，また盲腸に単発の若年性ポリープが証明され，早期胃癌を合併する若年性胃腸管ポリポージスと診断された．その臨床的所見と経過，病理学的所見などを供覧すると共に，若年性胃腸管ポリポージスの癌化の問題などを中心に本例の意義について若干の文献的考察を行った．

　A 65-year-old man with generalized gastrointestinal juvenile polyposis, especially, one of which was admixed with an early carcinoma in the remnant stomach, was reported and the previously reported cases were reviewed.

　The patient underwent partial gastrectomy for chronic gastric ulcer 11 years ago. He complained of anal pain for the first time in August 1981. Upper gastrointestinal series and endoscopic examination revealed a polypoid lesion diagnosed as type Ⅰ early cancer in the remnant stomach. At the same time several polyps were found in the remnant stomach, caecum, and ascending colon. Total extirpation of the remnant stomach was performed to gastric carcinoma. Cecal polyp was also removed endoscopically. In the resected specimen of the stomach, there were not only a large hemispherical polypoid lesion in the cardia just distal to the esophago-cardiac junction but also multiple small flat polyps in the whole surface of the remnant stomach. The multiple polyps were histologically diagnosed as juvenile polyposis. In the large polypoid lesion, well differentiated adenocarcinoma occupied the most part of the lesion, while the components having histological characteristics as a juvenile polyp were also found in the lower part of the lesion. The histological findings of the stroma in the carcinomatous tissues suggested a malignant transformation of the juvenile polyp into cancer. Invasion of the carcinoma remained in the mucosal layer. The cecal polyp had the similar histological findings as juvenile polyp.