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Stomach and Intestine(Tokyo) Volume 31, Issue 7 （June 1996）

胃と腸 31巻7号（1996年6月発行）

Japanese English

今月の主題遺伝性非ポリポーシス大腸癌（HNPCC）

主題

HNPCCと大腸腺腫 Clinicopathologic Features of Colorectal Adenomas in HNPCC 渡辺聡明 ¹ , 武藤徹一郎 ¹ Toshiaki Watanabe ¹ , Tetsuichiro Muto ¹ ¹東京大学医学部第1外科 ¹The First Department of Surgery, The University of Tokyo キーワード： HNPCC , 大腸腺腫 , cancer family syndrome , flat adenoma , 癌家族歴 Keyword: HNPCC , 大腸腺腫 , cancer family syndrome , flat adenoma , 癌家族歴 pp.841-849

発行日 1996年6月25日 Published Date 1996/6/25

DOI https://doi.org/10.11477/mf.1403104167

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Abstract 文献概要
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要旨　HNPCCの大腸腺腫は古くから大腸癌のprecursorとして重要であると考えられており，通常腺腫よりも悪性度が高いという報告もある．今回われわれは当科で手術施行したHNPCC42症例の大腸腺腫について検討した．対照は第一度近親者に癌家族歴がない大腸癌症例（501例）とした．両群とも大腸癌切除標本に認められた腺腫について検討した．平均年齢，男女比，腺腫の大きさ，異型度は両群問で差はなかった．腺腫頻度，腺腫多発頻度ともにHNPCC群が有意に高かった（45.3％ vs. 23.4％：p＜0.01）（28.6％. vs. 8.0％：p＜0.01）．腺腫が右側大腸に分布する比率は，HNPCCのほうが有意に高かった（60.0％ vs. 32.4％：p＜0.01）．flat adenomaの頻度はHNPCC群が高い傾向を示したが有意差は認められなかった（17.5％ vs. 7.3％：NS）．以上の結果から，HNPCCの腺腫の特微として，対照より頻度が高く，右側大腸に高頻度で分布するが傾向が認められた．しかし，悪性度に関しては，通常腺腫と有意差はないと考えられた．

　Adenomas have been reported to play an important role in the carcinogenesis of HNPCC (hereditary nonpolyposis colorectal carcinoma) . In some reports, the aggressive nature has been regarded as one of the characteristics of adenomas in HNPCC. We evaluated clinicopathologic features of adenomas in patients with HNPCC who had undergone operations for colorectal cancers. Diagnosis of HNPCC was made by the Japanese clinical criteria for HNPCC. Patients with surgically treated colorectal cancer whose first degree relatives did not have malignant disease were defined as control group. There were 42 patients in the HNPCC group, and 501 patients in the control group. In all cases, medical records of surgically removed specimens were examined retrospectively.

　The prevalence of adenomas was significantly higher in the HNPCC group than the control group (HNPCC 45.3% vs. control 23.4%, p＜0.01). Also the prevalence of multiple adenomas in an individual was significantly higher in the HNPCC group than in the control group (HNPCC 28.6% vs. control 8.0%, p＜0.01). There were no significant difference in the average age, sex ratio, size and degree of dysplasia between the two groups. Cancers and adenomas in HNPCC were more frequently found in the rightsided colon than those of control (p＜0.01). Flat adenomas were more frequently seen in the HNPCC than in the control (HNPCC 17.5% vs. control 7.3%), but there was no statistical difference. We demonstrated that adenoma may develop more frequently in HNPCC. However, the our study did not support the hypothesis that adenomas in HNPCC have more aggressive nature than those in the general population.