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Stomach and Intestine(Tokyo) Volume 43, Issue 13 （December 2008）

胃と腸 43巻13号（2008年12月発行）

Japanese English

今月の主題大腸癌の発生・発育進展

主題

大腸鋸歯状病変における発育進展・癌化―臨床の立場から Evolution of, and Carcinogenesis in, Colorectal Serrated Lesions ; Clinicopathological View 樫田博史 ¹ , 池原伸直 ¹ , 工藤進英 ¹ , 浜谷茂治 ² Hiroshi Kashida ¹ , Nobunao Ikehara ¹ , Shin-ei Kudo ¹ , Shigeharu Hamatani ² ¹昭和大学横浜市北部病院消化器センター ²昭和大学横浜市北部病院病理科 ¹Digestive Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan ²Division of Pathology, Showa University Northern Yokohama Hospital, Yokohama, Japan キーワード：鋸歯状腺腫 , 過形成性ポリープ , atypical hyperplastic polyp , 癌化 , 発育進展 Keyword: 鋸歯状腺腫 , 過形成性ポリープ , atypical hyperplastic polyp , 癌化 , 発育進展 pp.1897-1910

発行日 2008年12月25日 Published Date 2008/12/25

DOI https://doi.org/10.11477/mf.1403101534

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要旨　大腸鋸歯状病変をSA，THP，AHPの3群に分けて検討した．SA，THP は左側結腸に多いが，AHPは右側結腸に多かった．肉眼形態では，SA では隆起型が，THP，AHPでは平坦型が多かった．色調では，SAは発赤型が，THP，AHPは褪色・常色調が多かった．平均腫瘍径は，SA，AHPがTHPより有意に大きかった．拡大所見では松毬状や羊歯状を呈した病変の約90％がSA であり診断容易であるが，星芒状を呈した病変にはTHP以外にAHP，SAも少なからず含まれ診断困難であった．SAにはTHP由来とそうでないものがあると考えられた．鋸歯状病変の担癌例を13例経験した．5mm以上のSAのうち6.3％，5mm 以上のAHP中7.4％であったが，同時期の早期大腸癌 991 病変中1.1％，0.2％を占めるにすぎなかった．担癌 AHP 病変には SA 部分を認めず，SAを介した癌化とは別の pathway が存在するのではないかと思われた．鋸歯状病変の病理診断基準には大きな混乱が存在する．概念の整理・統一と，症例の集積が必要である．

　Colorectal serrated lesions were divided into three groups : serrated adenoma（SA）, typical hyperplastic polyp （THP） and atypical hyperplastic polyp （AHP）. Serrated adenomas and THPs had a preponderance of occurrence in the distal colon, whereas AHPs were more often found in the proximal colon. The majority of SAs presented as protruded lesions, but THPs and AHPs were mainly flat-elevated. Serrated adenomas were usually reddish in color, but THPs and AHPs were more often normochromatic or slightly pale. The average size of the lesions was substantially bigger among SAs and AHPs than in THPs. In magnifying colonoscopic view, around 90％ of the lesions with pinecone-like or fern-like pit pattern were SAs, but those with star-like pattern included not only THPs but also AHPs and SAs.

　There were 13 serrated lesions containing a cancerous part, whereas we encountered 991 early colorectal cancers as a whole during the same study period. Cancers were found in 6.3％ of SAs no smaller than 5mm ; which was equivalent to 1.1％ of all early cancers. Likewise cancers were found in 7.4％ of AHPs no smaller than 5mm ; which was equivalent to 0.2％ of all early cancers. Cancers occurring in AHPs were not associated with typical serrated adenomatous tissue. We speculate that carcinogenic pathways differ according to whether they are SAs or AHPs.

　There is confusion concerning the pathological diagnostic criteria and classification of serrated lesions. Accumulation of more cases and more discussion are necessary for the standardization of the concepts.