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Stomach and Intestine(Tokyo) Volume 26, Issue 7 （July 1991）

胃と腸 26巻7号（1991年7月発行）

Japanese English

今月の主題大腸sm癌の診断

主題

大腸sm癌の診断―X線診断の立場から Diagnosis of sm Cancer of the Large Intestine: With Special Reference to Its X-ray Diagnosis 坂谷新 ¹ , 小泉浩一 ¹ , 丸山雅一 ¹ , 太田博俊 ² , 畦倉薫 ² , 関誠 ² , 上野雅資 ² , 加藤洋 ³ , 柳沢昭夫 ³ Arata Sakatani ¹ , Koichi Koizumi ¹ , Masakazu Maruyama ¹ ¹癌研究会附属病院内科 ²癌研究会附属病院外科 ³癌研究会附属病院病理部 ¹Department of Internal Medicine, Cancer Institute Hospital キーワード：大腸sm癌 , 深達度 , 肉眼形態 , 変形 Keyword: 大腸sm癌 , 深達度 , 肉眼形態 , 変形 pp.726-735

発行日 1991年7月25日 Published Date 1991/7/25

DOI https://doi.org/10.11477/mf.1403102578

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要旨　大腸sm癌の浸潤程度と肉眼形態，大きさの関係を検討しsm癌の肉眼所見の特徴を調べた．Ⅰpはsm癌の18.4％（21/114）を占め，sm₃はなかった．また，10mm以下のsm₃癌はなかった．陥凹の要素は深達度の相対的な指標ではあるが絶対的な指標とはなりえなかった．無茎性大腸癌の注腸での側面像の変形を5分類し，深達度との関係を検討した．大腸sm癌は弓状変形～角状変形～半円状変形であった．側面像の変形を読影する際には病変が発生した部位による影響を考慮する必要がある．腸管内腔に対して凹の彎曲部に存在する病変は，変形を強く読影し深達度を深く読む必要がある．腸管内腔に対して凸の彎曲・彎入の強い部で，もともとの彎曲・彎入の幅程度の半円状変形であれば深達度は深くなく，m癌程度と読影すべきと考えられた．側面の変形を来す原因として，癌細胞の深部浸潤以外の要素に粘膜下層の線維化と固有筋層の肥厚が認められた．

　The degree of infiltration of sm cancer of the large intestine was examined to discover the relationship between infiltration depth and the macroscopic features such as shape and size of the lesion.Ⅰp represent 18.4％ (21/114 cases), and, among them, there were no cancers with sm₃ penetration which could be related to their macroscpic shape. Neither were there any cancers less than 10mm in diameter with a sm₃ degree of penetration. The element of central depression could be a possible index of penetration, but not an absolute one.

　Basal deformities of colic sessile cancer in profile view of enema were classified into five shapes to examine their respective relationships with the degree of penetration. Radiographically, sm cancers of the large intestine presented bow-shaped～wedge-shaped～semicircle-shaped deformities.

　When examining basal deformities in profile view, one needs to take into consideration the influence of the site of the lesion. Those lesions which are located in the concave curvature of the intestinal lumen should be investigated carefully as regards type of deformity and depth of penetration. Those semicircle-shaped deformities which are located in the strong convex curvature or indentation of the intestinal lumen, and are as wide as the original curvature or indentation were considered to be of shallow penetration and to be read as being the same as m cancer.

　Submucosal fibrosis and hypertrophy of the propria muscularis, rather than deep infiltration of cancer cells, were regarded as responsible for the lateral deformities.