内視鏡的切除を行った十二指腸Peutz-Jeghers型ポリープの1例

抄録

The patient was a 67-year-old woman in whom endoscopic retrograde cholangiopancreatography (ERCP) performed to treat choledocholithiasis revealed a 1.5-cm pedunculated polyp in the duodenum in October 2010. Pathological examination of a biopsy specimen showed no evidence of malignancy. In July 2012, the polyp had grown to 3.5 cm in diameter. The head of the polyp was lobular and red, and revealed no irregularity of the surface or vascular pattern on magnifying endoscopy with narrow-band imaging (NBI) . The stalk of the polyp showed no marked differences from the normal duodenal epithelium. Another biopsy specimen revealed arborecent hyperplasia of the muscularis mucosa, and a hamartomatous polyp was suspected. The patient was admitted to the hospital for endoscopic treatment in view of the possibility of malignancy. She underwent polypectomy; her subsequent clinical course was uneventful, and she was discharged from the hospital 8 days after treatment. The resected specimen showed a lobular polyp measuring 34×18×14 mm, and pathological examination confirmed the diagnosis of a hamartomatous polyp. She did not have any family history of Peutz-Jeghers (P-J) syndrome and showed no pigmented spots; therefore, P-J-type polyp was diagnosed. No recurrence or evidence of other polyps was seen on gastrointestinal endoscopy or colonoscopy performed 1 year after the treatment. P-J-type polyps are hamartomatous polyps with the same pathological findings as the polyps associated with P-J syndrome without the family history or pigmented spots. P-J-type polyps can cause bleeding and obstruction, and show potential for malignant transformation; therefore, treatment such as surgery or endoscopic removal is warranted. In addition, other areas of the gastrointestinal tract, including the small intestine, need to be examined to rule out multiple lesions.