多彩な消化管腫瘍を合併した腫瘤形成型大腸アミロイドーシスの1例  [in Japanese] A Case Report of Amyloidosis Forming Amyloid Tumors of Colon Complicated with Multiple Gastrointestinal Tumors  [in Japanese]

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Abstract

症例は66歳男性.便潜血反応陽性のため当科受診し,盲腸腫瘍を指摘され入院した.諸検査にて胃前庭部腫瘍,十二指腸球部ポリープ,盲腸の結節集籏様病変およびS状結腸の黄白色調多発粘膜下腫瘤を指摘した.前3者には手術を,S状結腸病変には内視鏡的粘膜切除を施行した,病理組織学的には胃前庭部腫瘍は粘膜下層まで浸潤した早期胃癌があり,その直下に平滑筋腫が併存していた.十二指腸ポリープは粘膜下層に主座を置くカルチノイドであり,盲腸の結節集籏様病変は粘膜層にとどまる腺管腺腫であった.S状結腸では粘膜下層に塊状のアミロイド沈着があり,それが黄白色腫瘤を形成していたが,他の消化管にはアミロイド沈着を証明しえなかった.アミロイドーシスに4種類もの多彩な消化管腫瘍を合併し,大腸にのみアミロイド沈着による腫瘤形成を認めたきわめて稀な1例であった.

A 66-year-old male was admitted to our hospital because a cecal tumor was indica-ted by barium enema, following a positive fecal occult blood test. After several examinations of antral protruding lesion resembling submucosal tumor, a sessile polypoid lesion in the duodenal bulb, a flat elevation with conglomerated nodular surface in the cecum and several yellow-white intramural tumors in the sigmoid colon were detected. He had undergone surgery for 3 lesions previously, and endoscopic mucosal resection was carried out to diagnose the lesion after surgery.<BR>Histopathologically, antral tumor was composed with two distinct parts, early gastric cancer overlying leiomyoma. The associated duodenal polyp was a carcinoid tumor proliferating in the submucosa and the associated cecal nodule-aggregating lesion was tubular adenoma within the mucosa.<BR>Histological study of the endoscopically removed specimen revealed that yellow-white protrusions in the sigmoid colon were caused by tumor-like massive amyloid depositions in the submucosa. Amyloid deposits were not found in any other part of the gastrointestinal tract.<BR>Amyloidosis complicated with four kinds of gastrointestinal tumors and tumor-like mass formation only in the colon throughout the gastrointestinal tract due to amyloidosis are uncommon.

Journal

  • Nippon Daicho Komonbyo Gakkai Zasshi

    Nippon Daicho Komonbyo Gakkai Zasshi 50(3), 196-203, 1997-03-01

    The Japan Society of Coloproctology

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