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要旨 早期大腸癌604病変(M癌300病変,SM癌304病変)を対象に,大腸癌の発育進展における鋸歯状病変の意義を検討した.鋸歯状病変はHP,SSP,TSA,SADに分類した.M癌においてHP ,SSP,TSA,SADの合併率はそれぞれ31.3%,2.0%,12.7%,5.3%であった.SM癌においてHP ,SSP,TSA,SADの合併率はそれぞれ43.4%,1.0%,9.2%,4.9%であった.SSP合併例は全例が右側大腸に存在し,TSA合併例は左側大腸に多かった.胃型形質は,SSP,TSAの鋸歯状病変部では全例に発現がみられたが,癌部では発現率が低下した.早期癌全体で,SSP,TSA,SADの少なくとも1つが合併した病変の頻度は13.9%であった.この値が鋸歯状病変由来の大腸癌の頻度に相当すると推測され,serrated pathwayは大腸癌の発育進展において無視できない割合を占めると考えられた.しかし,大腸鋸歯状病変は用語の統一や診断基準の確立などの解決されていない問題点を残しており,さらなる検証が必要である.
We investigated 604 early colorectal cancers(intramucosal cancer ; 300 lesions, submucosally invasive cancer ; 304 lesions)to estimate the significance of the serrated lesion in the development of colorectal cancer. Serrated lesions were classified into the following four categories. ① Hyperplastic polyp(HP), ② Sessile serrated polyp/Sessile serrated adenoma(SSP), ③ Traditional serrated adenomas(TSA), ④ Serrated adenocarcinoma(SAD).
In intramucosal cancer, the incidence of HP, SSP, TSA and SAD were 31.3%, 2.0%, 12.7% and 5.3%, respectively. In submucosally invasive cancer, the incidence of HP, SSP, TSA and SAD were 43.4%, 1.0%, 9.2% and 4.9%, respectively. All lesions with SSP were located in the proximal colon. Lesions with TSA tended to be located in the distal colon and rectum. Gastric-type mucin in the serrated component was detected in all lesions with SSP and TSA, but the incidence of gastric-type mucin decreased in the carcinoma component.
Among all early colorectal cancers,84 lesions(13.9%)were accompanied with SSP,TSA, or SAD. Therefore, it is thought that the serrated pathway when development of colorectal cancer accounts for a ratio that we cannot ignore. However, there are many problems involved in the colorectal serrated lesions that are not yet solved. For example the unification of the term or the establishment of the diagnostic criteria. Further study using the molecular biologic method will be necessary in the future.
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