“結節集簇様大腸病変”の画像診断とその経過

Nodule-aggregating Lesions of the Colon: Radiologic and Endoscopic Diagnosis and Their Clinical Courses

要旨　国立がんセンターで1991年8月までに結節集簇様病変と診断された62症例63病変と随伴性の結節集簇様病変（病変の一部～大部分に結節集簇様病変を認めるもの）10症例10病変を対象に検討した．平均年齢61.9歳，男女比は約3：2であった．結節集簇様病変のX線・内視鏡所見では病変の拡がりに比べて背が低く，平盤状の形態を示し，表面は大小の結節（1～7mm）の集簇から成っていた．生検結果は腺腫が多く，63例中26例は絨毛管状腺腫，17例は管状絨毛腺腫であった．病変全体が切除された25例では16例が腺腫，8例が腺腫内癌，1例のみsmへの浸潤癌であり，治療法の選択に際し，過大な手術を避ける必要がある．随伴性の結節集簇様病変10例中9例において，隆起あるいは無構造な陥凹部分でsmあるいはpm以上の癌の浸潤が認められた．経過観察された7症例では結節集簇様病変の発育進展はゆっくりであり，数mmの結節の集合した初期像から結節の数と大きさを増大させながら，結節の集簇した形態を保持したまま発育していくと推測された．また，異時性・同時性の大腸癌15例，他臓器癌13例（胃癌5例，乳癌2例，甲状腺癌2例，皮膚癌，卵巣癌，肺癌，食道癌各1例）の合併がみられた．また，cancer family syndromeが2例含まれていた．

　Purpose of this paper is to analyze cases of nodule-aggregating lesions and lesions accompanied nodule-aggregating components of the colon in National Cancer Center. The number of analyzed lesions are 63 (from 62 cases) of nodule-aggregating lesions and 10 (from 10 cases) of lesions accompanied nodule-aggregating components which are designated as lesions which contain nodule-aggregating lesions. The average age of these cases was 61.9 year-old. Male to female ratio was about 3 to 2. The typical findings of nodule-aggregating lesions in x-ray and endoscopic examination is that lesions are dish-like shaped with coalescence of various sized nodules (1-7 mm in size) on the surface and the height is very low compared to their extent. The most common result of the specimens from biopsy was adenoma: 26 out of 63 cases were villous tubular adenoma, 17 cases were tubular villous adenoma. The specimens from 25 cases of surgical resection revealed 16 cases of adenoma, 8 cases of cancer in adenoma and only 1 case of cancer invading submucosal layer (sm). These results suggest that exces sive surgical treatment should be avoided. On the contrary, 9 out of 10 cases of lesions accompanied nodule-aggregating components had cancer invading sm or pm on the elevated and/or depressed area.

　We followed 7 cases of nodule-aggregating lesions and found they tend to develop slowly. Initial picture of nodule-aggregating lesions is coalescence of nodules, several mm in size. They seem to increase number and size of nodules but shape of them remains the same. There were concomitant and/or successively developed 15 cases of cancer of the colon and 13 cases of cancer of the other organs (stomach 15 cases, breast 5 cases, thyroid 5 cases and skin, ovary, lung, and esophagus 1 case respectively). Two cases of cancer family syndrome were also found in those who had nodule-aggregating lesions.