A Case of Lipoma Presenting as an Inflammatory Fibroid Polyp on Preoperative Clonoscopy
نویسندگان
چکیده
Inflammatory fibroid polyp(以下,IFP)が疑われ, 術前診断で IFPとの鑑別に苦慮した横行結腸脂肪腫 の1例を経験したので文献的考察を加え報告する. 症 例 症例:76歳,女性. 主訴:下腹部痛,軟便. 既往歴:1999年,子宮筋腫で子宮摘出術. 家族歴:特記すべき事項なし. 現病歴:2010年12月初旬より下痢,下腹部痛が出現 し,その後軟便が持続するため当院受診.大腸内視鏡 検査で横行結腸腫瘍を指摘され精査加療目的に当科紹 介となった. 家族歴:特記すべき事項なし. 現症:身長152.2cm,体重53.1kg,眼球結膜に貧血・ 黄疸を認めず.腹部は平坦・軟で腫瘤を触知しなかった. 入院時血液検査所見:血液一般,生化学検査で異常 を認めず,腫瘍マーカーはCEA:2.4ng/ml,CA199:7.4U/mlであり正常範囲内であった. 大腸内視鏡検査:横行結腸に頂部表面に,びらん・ 潰瘍を伴う陰茎亀頭様ポリープを認めた(Fig.1).生 検の結果は,granulation tissueで確定診断には至らな かった. 腹部 CT検査:横行結腸に39mmの低吸収域腫瘤を 先進部とする腸重積を認めた(Fig.2). 腹部CT検査より,下腹部痛は横行結腸腫瘤を先進 部とした腸重積が原因と診断した.内視鏡所見からは, IFPが疑われ,腹部CT検査では横行結腸脂肪腫が疑 われ術前診断に苦慮した.確定診断に至らないまま腸 重積解除および確定診断を目的に腹腔鏡下横行結腸部 分切除術を施行した(Fig.3). 病理組織学的所見:腫瘍頂部の潰瘍底に線維化およ び肉芽組織の増生が認められた.腫瘍の主座は粘膜下 層で,成熟した脂肪組織が不規則に増生しており脂肪 腫と診断した(Fig.4A,B,C). 術後経過は良好で第7病日目に退院された. 考 察 Inflammatory fibroid polyp(IFP)は,消化管に発 生する好酸球浸潤を伴うpolyp病変で,1920年にKonjetzny が最初にpolypoid fibromaと報告した.1953
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