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Stomach and Intestine(Tokyo) Volume 43, Issue 9 （August 2008）

胃と腸 43巻9号（2008年8月発行）

Japanese English

今月の主題 colitic cancer/dysplasiaの早期診断─病理組織診断の問題点も含めて

主題

colitic cancer/dysplasiaの画像診断―拡大内視鏡を中心に Magnifying Endoscopy for the Diagnosis of Colorectal Cancer and Dysplasia-associated with Ulcerative Colitis 岩男泰 ¹ , 三上修治 ¹ , 向井萬起男 ² , 松岡克善 ² , 日比紀文 ³ , 長谷川博俊 ⁴ , 杉野吉則 ⁵ Yasushi Iwao ¹ , Shuji Mikami ¹ , Makio Mukai ² , Katsuyoshi Matsuoka ² , Toshifumi Hibi ³ , Hirotoshi Hasegawa ⁴ , Yoshinori Sugino ⁵ ¹慶應義塾大学包括先進医療センター ²慶應義塾大学包括先進医療センター病理診断部 ³慶應義塾大学包括先進医療センター消化器内科 ⁴慶應義塾大学包括先進医療センター一般消化器外科 ⁵慶應義塾大学包括先進医療センター放射線診断科 ¹Center for Comprehensive and Advanced Medicine, Keio University School of Medicine, Tokyo ²Department of Pathology, Keio University School of Medicine, Tokyo ³Division of Gastroenterology, Department of Internal Medicine, Keio University School of Medicine, Tokyo ⁴Department of Surgery, Keio University School of Medicine, Tokyo ⁵Department of Diagnostic Radiology, Keio University School of Medicine, Tokyo キーワード： ulcerative colitis , dysplasia , colitic cancer , 拡大内視鏡 , pit pattern Keyword: ulcerative colitis , dysplasia , colitic cancer , 拡大内視鏡 , pit pattern pp.1303-1319

発行日 2008年8月25日 Published Date 2008/8/25

DOI https://doi.org/10.11477/mf.1403101444

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要旨　潰瘍性大腸炎に合併した癌，dysplasiaの内視鏡所見を拡大内視鏡像を中心に解析し，病理組織像と対比して以下の結果を得た．①早期癌形態のうち隆起型は79％，平坦型・陥凹型が21％であった．②色調は発赤を呈する病変が73％を占め，平坦型の全病変が発赤として認識されていた．③pit patternの解析ではLGD以上の病変すべてに腫瘍性pitが認識できた．④30％の病変に複数のpit patternが観察された．⑤IVv型が77％の病変に認められ，特に隆起型では88％と大多数を占めた．⑥平坦型病変ではIIIl型が60％，IVv型が50％に観察された．⑦IVb型の5病変のうち4病変はIIIl型と混在してみられ，5病変ともVi型を伴っていた．以上，UC関連腫瘍の示すpit patternはIVv型が多数を占めるが，平坦型においてはIVv型を主体とする病変と，IIIl型，IVb型を主体とする病変が存在することがわかった．両者の発生・進展過程を検討するうえでも，IV型亜分類の必要性が示唆された．平坦型病変の発見には絨毛状の粘膜，発赤などに注意し，積極的に拡大観察を行うことが必要である．

　Background:An increased risk of developing colorectal cancer（CRC）has been reported in patients with long-standing ulcerative colitis（UC）and cancer surveillance is recommended. The development of new endoscopic techniques to detect flat dysplastic lesions is required.

　Aim:We investigated conventional and magnifying endoscopic features of UC associated dysplasia and CRC, comparing them with their pathological findings.

　Method:Fifty three lesions of dysplasia and early stage CRC associated with UC were included in this study and we analyzed their macroscopic structure, mucosal color and the pit pattern of them. High-magnification findings were classified according to the modified criteria of Kudo. In addition, we furthermore classified type IV pit pattern into IV villous（IVv）and IV branched（IVb）.

　Results:Forty two lesions（79％）were the protruded type, 11 lesions（21％）were superficial type, such as flat and/or depressed type. Most lesions were identified as reddish in color. All of 30 lesions examined by magnifying endoscopy showed tumorous pit patterns（IIIs/IIIl/IV/Vi）. Type IVv pit pattern was identified in 77％ of all lesions, especially in 88％ of the protruded type lesions. Type IIIl pit pattern was observed in 60％ of the superficial type lesions. Type IIIs pit pattern was detected in 2 lesions, accompanied with type IIIl pit pattern. Type IVb pit pattern is detected in 5 lesions, 4 of which were intermingled with type IIIs and/or IIIl pit patterns.

　Conclusion:Type IVv is the main pit pattern among the neoplastic lesions associated with UC, especially among protruded lesions. On the other hand, type IIIl/IIIs/IVb pit patterns are dominant among flat lesions. Further studies are necessary for establishing the role of magnifying endoscopy in the diagnosis of flat dysplasia and CRC associated with UC.