内視鏡的粘膜切除術を施行した直腸良性リンパろ胞性ポリープの１例

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  • A Case of Benign Lymphoid Polyp of the Rectum Resected by Eendoscopic Mucosal Resection.

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A 65-year-old man was admitted to our hospital for discomfort of the left flank. The immunological fecal occult blood testing was positive. A double contrast study of the colon and rectum showed the colonic protruded lesions and a rectal submucosal tumor. Colonoscopy demonstrated polyps of the ascending colon and a protruding lesion with uneven-surfaced mucosa of the rectum. Endoscopic ultrasonography (20MHz probe : Olympus UM-3R) revealed a localized mass, 1 cm in diameter, in the submucosal layer, including a part of the second and third layers, which showed spheric and hypoechoic features with clear border. The internal echo of the mass was nearly uniform, but a part of the mass appeared high echoic features. Endoscopic mucosal resection was performed in order to establish the diagnosis. Path-ologically, the resected tumor was composed of proliferating lymph follicles with germinal centers in the submucosal layer, but lymphocytes of lymph follicles had no atypia and mono-clonality in the immunological staining. We finally diagnosed the tumor as benign lymphoid polyp of the rectum (so-called rectal tonsil). Benign lymphoid polyp of the colon and rectum is a popular disease in Western countries, but comparatively rare in Japan. This case illustrates many problems in diagnosing benign lymphoid polyp, and it seems to be difficult to distinguish benign lymphoid polyp from mucosa -associated lymphoid tissue (MALT) type malignant lymphoma of the colon and rectum as differential diagnosis.

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