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Stomach and Intestine(Tokyo) Volume 30, Issue 2 （February 1995）

胃と腸 30巻2号（1995年2月発行）

Japanese English

今月の主題表面型大腸癌の発育と経過

主題

表面型起源大腸sm癌の形態学的特徴―粘膜内部残存sm癌を用いた検討 Morphological Characteristics of Colorectal Carcinomas Originating from Superficial Type Intramucosal Carcinomas 味岡洋一 ¹ , 渡辺英伸 ¹ , 小林正明 ¹ , 吉田光宏 ² , 斉藤英俊 ¹ , 佐々木正貴 ¹ Yoichi Ajioka ¹ , Hidenobu Watanabe ¹ , Masaaki Kobayashi ¹ ¹新潟大学医学部第1病理 ²東邦大学医学部第3内科 ¹The First Department of Pathology, Niigata University School of Medicine キーワード：大腸sm癌 , 粘膜内部残存sm癌 , 表面型起源癌 , 起源粘膜内癌 Keyword: 大腸sm癌 , 粘膜内部残存sm癌 , 表面型起源癌 , 起源粘膜内癌 pp.149-164

発行日 1995年2月25日 Published Date 1995/2/25

DOI https://doi.org/10.11477/mf.1403105310

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要旨　大腸sm癌176病変は，粘膜内部残存癌（106病変，60.2％）と，粘膜内部非残存癌（70病変，39.8％）とに分けられた．粘膜内部残存sm癌で，その残存粘膜内部の厚さが表面型（隆起型）粘膜内腫瘍のそれに相当するものを表面型（隆起型）粘膜内癌起源と規定し，表面型粘膜内癌起源sm癌の肉眼的特徴を検討した．表面型粘膜内癌起源sm癌に特徴的な肉眼所見は，有茎性病変がないことと隆起型病変ではその表面形態が扁平か陥凹局面から成ることであった．また，隆起起始部で粘膜内腫瘍と周辺非腫瘍性粘膜とがなだらかな移行を示すものは，表面型粘膜内癌起源と考えられた．起源粘膜内癌別にみたsm癌の発育様式の検討から，粘膜内部非残存sm癌の中で，大きさ15mm未満の無茎性病変は表面型粘膜内癌起源と考えられた．それらの中でもⅡa型病変は，全例がⅡb・Ⅱc型粘膜内癌を起源とした癌と考えられた。表面型粘膜内癌起源sm癌の残存粘膜内部は，1型起源sm癌に比べ高異型度癌が占める割合が高く，腺腫併存率は有意に低値であった（腺腫併存例の割合が，Ⅱa型粘膜内癌起源癌で22.9％，Ⅱb・Ⅱc型粘膜内癌起源癌で0％）．すなわち，表面型粘膜内腫瘍の中でsm浸潤を来すものは(進行癌の初期病変となるものは)，de novo発生で低異型度癌から高異型度癌へのprogressionが早期に起こったものと考えられた．

　One hundred and seventy-six colorectal submucosal carcinomas were classified into the following two groups ; those with remnant intramucosal part (106/ 176, 60.2%) and those without (70/ 176, 39.8%) . The former were then divided into those originating from superficial type (type Ⅱ) intramucosal carcinomas and those origrating from polypoid type (type Ⅰ) intramucosal carcinomas, judging by the width of the remnant intramucosal part. Submucosal carcinomas originating from type Ⅱ intramucosal had the macroscopic characteristics of a sessile lesion with flat or depressed surface and smooth transition of neoplastic mucosa to the surrounding non-neoplastic mucosa. In the case of submucosal carcinomas without remnant intramucosal part, it was speculated that sessile lesions less than 15 mm in size had originated from type Ⅱ intramucosal carcinomas. Among them, type Ⅱa lesions were regarded as having originated from type Ⅱb・Ⅱc intramucosal carcinomas. Histologically, the intramucosal part of submucosal carcinomas originating from type Ⅱ carcinoma were characterized by a low incidence of accompanying adenomas, and a high incidence of carcinoma with high grade atypia, compared to those originating from type Ⅰ carcinoma. Among type Ⅱ intramucosal carcinomas, those showing submucosal invasion were thought to be de novo origin and their progression from low grade carcinomas to high grade carcinomas thought to have taken place at a stage earlier than that of type I carcinomas.