若年性ポリポーシスに横行結腸腺腫を合併し大腸全摘術を施行した1例 A Case of Juvenile Polyposis Accompanied by Transverse Colon Adenoma in Whom Total Colectomy was Performed

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症例は56歳男性.大腸疾患の家族歴はない.健診で貧血を指摘され近医を受診し,注腸造影検査で多発性ポリープおよび横行結腸腫瘍を指摘され,当院外科に紹介受診となった.大腸内視鏡検査を行い上行結腸と直腸からS状結腸にかけて有茎性ポリープを認め,その一部を内視鏡的切除した.また,CTにて横行結腸に径4cmの腫瘍性病変を認めた.治療方針としては,上行結腸·横行結腸·S状結腸から直腸の3カ所に病変が存在したため大腸全摘術を選択した.摘出標本の病理診断は(1)上行結腸·S状結腸から直腸の有茎性ポリープは若年性ポリープ(2)横行結腸の亜有茎性腫瘍は高度異型腺腫の診断であった.<br> 若年性ポリポーシスは,過誤腫のために腺腫性ポリポーシスと比較して悪性腫瘍との関連性が低いとされてきたが,最近では前癌状態であることを示唆する報告もある.今回,若年性ポリポーシスと同時性高度異型腺腫の切除症例を経験したので文献的考察も加えて報告する.<br>

A fifty-six years-old man without a particular colorectal family history was referred to a near-by clinic due to anemia found during a health care examination. At the clinic, multiple colon polyps and a tumor in the transverse colon were found as a result of barium enema examination. He was referred to our hospital and, by means of colonoscopic examination, numerous pedunculated type polyps were identified from the cecum through the rectum. Colonoscopic polypectomy was performed on some of the ascending colon polyps. Since a tumor-like lesion with a diameter of 4cm was also identified by enhanced CT, total colectomy was performed. By histopathological examination, pedunculated polyps densely distributed around the rectum and polyps of ascending colon were diagnosed as juvenile polyps and a tumor in the transverse colon was identified as tubulovillous adenoma (severe atypia).<br> Compared with adenomatous polyposis, cases of juvenile polyposis have been reported as being poorly related with malignant tumors since it is classified as a teratoma. However, the number of reports in which juvenile polyposis may represent a pre-cancerous state have been increasing. Here we report a case of juvenile polyposis accompanied by tubulovillous adenoma with severe atypia, as well as on a review of related papers.<br>

収録刊行物

  • 日本大腸肛門病学会雑誌  

    日本大腸肛門病学会雑誌 61(3), 107-111, 2008-03-01 

    The Japan Society of Coloproctology

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各種コード

  • NII論文ID(NAID)
    10021302977
  • NII書誌ID(NCID)
    AN00195100
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    00471801
  • データ提供元
    CJP書誌  CJP引用  J-STAGE 
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