大腸憩室疾患に伴う粘膜脱症候群様病変の2例 Two Cases of Mucosal Prolapse Syndrome-like Lesions with Colonic Diverticulosis

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大腸憩室疾患に伴う稀な粘膜脱症候群様病変2症例を経験した．大腸憩室疾患で長期経過観察中に憩室多発部位にみられた病変である．内視鏡所見は，境界不明瞭な発赤調の多発した粘膜下腫瘍様形態であった．病理学的には粘膜筋板から粘膜固有層上方へ伸びる平滑筋線維の増生，いわゆる線維筋症を認め，直腸にみられる粘膜脱症候群に類似した所見であった．経過中，腺腫や早期癌の併存がみられ，内視鏡摘除を施行した．本病変の確定診断には生検による病理診断が有用であり，腫瘍性病変と鑑別が困難な場合は内視鏡摘除が必要である．わが国では大腸憩室疾患が増加傾向にあり，今後本病変に遭遇する機会が増加することが予想される．憩室多発例では本病変を念頭に入れ，内視鏡観察をすべきである．

Two cases of mucosal prolapse syndrome (MPS)-like lesions associated with colonic diverticulosis were treated in our hospital. The lesions were located in a region of the colon, where multiple diverticula were observed during long-term follow-up. Endoscopic findings showed poorly bordered, reddened and multiple submucosal tumor-like lesions. Pathological findings showed characteristic and pathognomonic fibromuscular obliteration, where upward extending smooth muscle fibers from the lamina muscularis mucosae were observed within the lamina propria. These findings were identical with those observed in rectal MPS. The present cases were accompanied with colonic adenoma or early colorectal carcinoma. Therefore, all the lesions including the neoplastic lesions were endoscopically resected simultaneously. Biopsy is useful to confirm final diagnosis of these lesions. In the case where differential diagnosis between MPS-like lesions and neoplastic lesions is exceptionally difficult, it is necessary to resect lesions endoscopically. Recently, the number of patients with colonic diverticulosis has been increasing in Japan, and at the same time, occurrences of MPS-like lesions are also expected to increase. Therefore, during an endoscopic examination in cases with multiple colonic diverticular lesions, it is necessary to bear those lesions in mind for the differential diagnosis.

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 65(4), 209-213, 2012-04-01

    The Japan Society of Coloproctology

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