胃と腸59巻2号

2024年02月発行

今月の主題 大腸ポリープのすべて 主題

—大腸上皮性ポリープの鑑別診断—非腫瘍性ポリープ—内視鏡診断の立場から

著者： 川崎啓祐¹ 梅野淳嗣¹ 蔵原晃一² 江頭信二郎² 谷口義章¹³ 大城由美⁴ 川床慎一郎¹³ 長末智寛¹ 松野雄一¹ 藤岡審¹ 川久保尚徳⁵ 永田公二⁵ 森山智彦¹⁶ 田尻達郎⁵ 鳥巣剛弘¹

所属機関： ¹九州大学大学院医学研究院病態機能内科学 ²松山赤十字病院胃腸センター ³九州大学大学院医学研究院形態機能病理学 ⁴松山赤十字病院病理診断科 ⁵九州大学大学院医学研究院小児外科学分野 ⁶九州大学病院国際医療部

ページ範囲：P.171 - P.181

要旨●過去23年間に当科および関連施設にて診断された大腸の孤立性若年性ポリープ（JP）101例，孤立性PJP（Peutz-Jeghers type polyp）29例，IMGP（inflammatory myoglandular polyp）18例を対象とし，その臨床像，内視鏡像，病理組織像を遡及的に検討した．その結果，JPは平均年齢が低かった．内視鏡所見では，JPはびらん，白苔，白斑，NBI拡大観察下の開大した腺管開口部や疎に分布した腺窩辺縁上皮，細かい血管の増生，色素拡大観察下の星芒状，疎に分布したpitの，PJPは分葉状，NBIや色素拡大観察下の樹枝状構造の，IMGPは白斑，NBI拡大観察下の開大した腺管開口部，細かい血管の増生，色素拡大観察下の星芒状pitの頻度がそれぞれ高かった．以上よりJP，IMGPとPJPは異なる内視鏡像を呈していたが，JPとIMGPの内視鏡像は比較的類似していた．しかしながら，JPはIMGPに比べ，白苔，NBIや色素拡大観察下の疎に分布する腺窩辺縁上皮やpitの頻度が高いことを加味すると鑑別できる可能性があるものと推察する．

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