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要旨 患者は74歳,男性.上行結腸癌,S状結腸癌術前内視鏡検査で直腸Raに10mmの,病変口側と肛門側に小結節状隆起を伴う丈の低い正色調の扁平隆起を認め,HP(hyperplastic polyp)と診断され経過観察となった.1年後,術後followの内視鏡再検査で,病変は20mmと増大し隆起成分も増大していた.SSA/P(sessile serrated adenoma/polyp)にSA(serrated adenoma)またはTA(tubular adenoma)を伴う病変と診断し,内視鏡的粘膜下層剝離術にて一括切除した.病理所見では,丈の低い隆起はSSA/Pで口側小隆起成分はTA,また肛側隆起成分はSAであった.まだ症例数は少ないが,本症例のように右側結腸のSSA/Pとは異なり,左側結腸のSSA/PからはSAやTAを併発する経路が存在する.平坦なHPの中に周囲にSAを伴う癌が存在する症例や,SAの癌化が左側に多いという事実を踏まえると,左側のSSA/Pに関しては,右側のようにde novo型の癌化ではなく,SAまたはTAを介して癌化していく可能性が示唆される.
A 76-year old male performed colonoscopy before surgery for advanced ascending and sigmoid cancer. A slightly elevated lesion with two nodules whose size was 10mm was detected and diagnosed as hyperplastic lesion. In 1year after surgery, the lesion size increased up to 20mm. Finally we diagnosed the lesion as sessile serrated adenoma with serrated adenoma or tubular adenoma, we performed en block resection using ESD technique. Histopathological diagnosis was as follow, SSA/P for slightly elevated lesion, serrated adenoma for anal nodule and tubular adenoma for oral nodule. Some reports have also supported serrated adenoma or tubular adenoma occurred within SSA/P located left side of colon. We assumed that serrated or tubular adenoma occurred in SSA/P located left side of colon will develop carcinoma in contrast to SSA/P located right side of colon in which carcinoma occurred as de novo pathway.
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