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Stomach and Intestine(Tokyo) Volume 46, Issue 4 （April 2011）

胃と腸 46巻4号（2011年4月発行）

Japanese English

今月の主題大腸鋸歯状病変と癌化

主題

癌併存大腸広基性鋸歯状腺腫/ポリープの臨床病理学的特徴 Clinicopathological Characteristics of Sessile Serrated Adenoma/Polyp with Dysplasia and Carcinoma 三富弘之 ¹ , 五十嵐誠治 ² , 伴慎一 ³ , 九嶋亮二 ⁴ , 藤田恒平 ⁵ , 平橋美奈子 ⁵ , 大城由美 ⁶ , 林大久生 ¹ , 八尾隆史 ¹ Hiroyuki Mitomi ¹ , Seiji Igarashi ² , Shin-ichi Ban ³ , Ryoji Kushima ⁴ , Kohei Hujita ⁵ , Minako Hirahashi ⁵ , Yumi Ohshiro ⁶ , Takuo Hayashi ¹ , Takashi Yao ¹ ¹順天堂大学医学部人体病理病態学講座 ²栃木県立がんセンター臨床検査部病理診断科 ³済生会川口総合病院病理診断科 ⁴国立がん研究センター中央病院病理科 ⁵九州大学大学院医学研究院形態機能病理学 ⁶松山赤十字病院病理部 ¹Department of Human Pathology, Juntendo University School of Medicine, Tokyo ²Divison of Pathology, Tochigi Cancer Center, Tochigi, Japan ³Department of Pathology, Saiseikai Kawaguchi General Hospital, Kawaguchi, Japan ⁴Clinical Laboratory Divison, National Cancer Center Hospital, Tokyo ⁵Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ⁶Department of Pathology, Japanese Red Cross Matsuyama Hospital, Matsuyama, Japan キーワード：広基性鋸歯状ポリープ , 大腸 , 癌化 , 組織所見 , serrated dysplasia Keyword: 広基性鋸歯状ポリープ , 大腸 , 癌化 , 組織所見 , serrated dysplasia pp.384-393

発行日 2011年4月25日 Published Date 2011/4/25

DOI https://doi.org/10.11477/mf.1403102175

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要旨　癌併存大腸広基性鋸歯状腺腫/ポリープ（sessile serrated adenoma/polyp ; SSA/P）37例49病変の以下のような臨床病理組織学的特徴を抽出できた．（1）高齢女性の右半結腸の広基性病変が多い，（2）粘膜下層浸潤（SM）癌が多い，（3）粘膜内（M）癌とSM癌では腫瘍全体の大きさに差はないが，癌部の大きさはSM癌が有意に大きい，（4）serrated type dysplasiaを伴う例が多い，（5）低異型度分化型腺癌が多い，（6）conventional type carcinomaを伴う例は，M癌ではSM癌に比し有意に少ない，（7）粘液癌併存例が比較的多い，（8）癌腺管構造の特徴をみるとM，SM癌ともに鋸歯状構造を示す例が多いが，M癌では小型の腺管形成が多く，SM癌では篩状構造が多くみられる，（9）小型の円形核を有する例が多い，（10）SM癌においても癌間質の炎症細胞浸潤は軽度で，線維化のない例が多い，（11）SSA/P部分の組織所見では腺底部の鋸歯状変化，分岐腺管，表層微小乳頭状増生巣，拡張腺管，水平腺管が多く観察された．以上より，癌併存SSA/Pはconventional typeの腺腫内癌とは異なる臨床病理学的特徴を有する特異な腫瘍と考えられる．

　To clarify the clinicopathological features of SSA/P（sessile serrated adenoma/polyp）with dysplasia and carcinoma, we studied 37 cases（49 lesions）of these tumors. Patients with SSA/P with dysplasia and carcinoma were found more frequently in older females. These tumors were more likely to be broad-based and located in the right colon. No significant differences in maximum diameter of the whole lesion were observed between mucosal and submucosal tumors, but the maximum diameter of the cancerous area was larger in submucosal tumors as compared to intramucosal carcinoma. Most of these tumors were low-grade adenocarcinoma of well differentiated type invading into the submucosa and the coexisted with low- and high- grade serrated type dysplasia. Carcinoma with mucinous differentiation was relatively common among the submucosal tumors. Conventional carcinoma component was less frequently observed in intramucosal carcinomas than in submucosal invasive tumor. We often found both intramucosal and submucosal carcinoma consisted of serrated glands, small glandular pattern in the mucosa and cribriform structure in the submucosa. Small round or oval nuclei were characteristic of these tumors. Stromal reaction including inflammatory cell infiltration and fibrosis was rarely seen in the submucosal invading area. SSA/P frequently demonstrated exaggerated serration in the lower crypt, branching crypt and small tuft or villosity of the surface epithelium. Taken together, SSA/P with dysplasia and carcinoma seems to be distinct tumor entities.