Journal Article Gastric Hyperplastic Polyp with Xanthoma Observed by Magnification Narrow-Band Imaging Endoscopy and Endoscopic Ultrasonography : Report of a Case

Fukuda, Shin-ichiro  ,  Akahoshi, Kazuya  ,  Fushimi, Fumiyoshi  ,  Oya, Masafumi

106 ( 4 )  , pp.77 - 82 , 2015-04-25 , Fukuoka Medical Association
We experienced an extremely rare case of gastric hyperplastic polyp with xanthoma. A 73-year-old Japanese man was transferred to our hospital from a referral hospital for further evaluation of a pedunculated gastric polyp and early gastric cancer. Esophagogastroduodenoscopy (EGD) revealed a yellow-whitish pedunculated polyp arising from the anterior wall of the fornix. Magnification narrow-band imaging (NBI) endoscopy revealed extended and tortuous microcapillaries and a swollen interfoveolar pattern on the polyp’s surface, but there was no sign of malignancy. Endoscopic ultrasonography (EUS) revealed an irregularity of the first layer and a thickened second layer. The third layer was intact. A hyperechoic area was seen in the thickened second layer. Endoscopic submucosal dissection (ESD) for early carcinoma of the antrum and endoscopic mucosal resection (EMR) for a polyp in the fornix were performed in one session. Histological examination of the specimen of the fornix polyp revealed lengthened, branched and dilatated gastric foveolae and a tight sheet of foamy histiocytes in the stroma. The background mucosa of the polyp was atrophic. The pathologic evidence was gastric hyperplastic polyp with proliferation of xanthoma. The early cancer of the antrum was intramucosal tubular adenocarcinoma and was resected curatively.
今回,我々は極めてまれな黄色腫が混在した胃過形成ポリープの一例を経験した.症例は73歳男性.胃隆起性病変と早期胃癌の精査加療目的に当科紹介となった.当科で施行した上部消化管内視鏡検査(EGD)では,穹窿部前壁に黄白色調の隆起性病変を認めた.狭帯域光(NBI)による拡大観察では拡張,蛇行した微小血管構造,窩間部の膨化した表面構造を認めたが,明らかな悪性を示唆する所見は認めなかった.超音波内視鏡検査(EUS)では穹窿部前壁の病変は第1 層の不整と第2層の肥厚として描出され,第3層は保たれていた.肥厚した第2層の内部には高エコー領域が散見された.前庭部の早期胃癌に対する内視鏡的粘膜下層剥離術(ESD)と穹窿部の病変に対する内視鏡的粘膜切除術(EMR)を一期的に行なった.病理組織学的検索では穹窿部の病変は腺窩上皮が延長,分枝,拡張を伴う過形成変化を示し,また間質には泡沫組織球が著明に集簇していた.腫瘍背景は萎縮粘膜であった.以上の病理所見から黄色腫混在の胃過形成ポリープと診断された.前庭部の早期胃癌は,組織型は高分化腺癌であり,粘膜内病変で内視鏡的治癒切除が得られていた.

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