潰瘍性大腸炎における腫瘍性病変のX線・内視鏡診断

Endoscopic and Radiologic Diagnosis of Neoplastic Lesions in Patients with Ulcerative Colitis

要旨　潰瘍性大腸炎症例を対象として，①dysplasiaの出現頻度，②腫瘍性病変のX線・内視鏡所見，および③腫瘍性病変におけるX線像の経時的変化を検討した．①surveillance colonoscopyで採取された121生検標本中，dysplasiaが20標本にみられ，このうち17標本は顆粒状粘膜ないし結節状隆起から採取されていた．②腫瘍性病変を合併した10症例21病変は，内視鏡上明らかな隆起性病変11病変，顆粒状粘膜6病変，隆起と顆粒状粘膜の混在2病変，陥凹と顆粒状粘膜の混在1病変に分類可能であったが，粘膜内癌1病変は内視鏡上同定できなかった．③3例4病変のX線所見の遡及的検討では，3病変が活動期あるいは寛解期の粘膜から顆粒状粘膜として発生し，2病変では顆粒状粘膜が内視鏡診断に1年ないし6年先行して認められた．以上から潰瘍性大腸炎における腫瘍性病変の診断には隆起性病変と顆粒状粘膜に注目することが重要と思われた．この粘膜面の微細な変化はX線検査でも描出可能であるので，特に寛解期においては色素内視鏡を用いた内視鏡検査と二重造影法によるX線検査を併用することが本症における潰瘍性病変の診断上重要と考えられた．

　The endoscopic and radiographic features of cancer and dysplasia in patients with long-standing ulcerative colitis were investigated. Among 121 biopsy specimens obtained during surveillance colonoscopy in nine patients, 20 were diagnosed as dysplasia or cancer. Seventeen of these 20 specimens were obtained either from granular mucosa or from nodular elevations. In another investigation, 20 lesions with the established diagnosis of dysplasia or cancer were endoscopically and/or radiographically recognized as either nodular elevations (11 lesions), granular mucosa (six lesions), elevations accompanied by granular mucosa (two lesions), or a depression surrounded by granular mucosa (one lesion). However, we failed to identify one cancer preoperatively. The radiographic features of the granular mucosa were characterized by minute protrusions accompanied by irregular contours. These findings suggest that dysplasia or cancer in ulcerative colitis can be recognized under colonoscopy, and that radiographs may become available for cancer surveillance programs for this disease.