大腸のvillous tumor

Forty-seven Lesions of Colorectal Villous Tumors

要旨　順天堂大学と千葉県がんセンターで経験した絨毛腫瘍45例47病変（絨毛腺腫21病変，腺管絨毛腺腫26病変）について検討した．自験例では進行癌はなく，sm癌は7cm以上にあった．絨毛腫瘍の肉眼形態から有茎・無茎・平盤状に分けた．有茎性が絨毛腫瘍の中で最も頻度が高い．この型では，有茎のX線所見を92％も得られた．無茎性は0.6cm以上で，2cm以上になるとm癌がみられた．この型では，表面結節性所見が内視鏡・X線で得られた．平盤状は2cm以上で，m癌は4cm以上でみられた．この型では，網状または結節性のX線所見をみる．絨毛腫瘍の診断は2cm以上で結節状ないし網状表面像と側面像で毛羽立ちをみると容易である．

　Histological study was made on the 47 lesions of villous tumors in 45 cases seen at Juntendo University and Chiba Cancer Hospital. Not a single advanced cancer was found in our series of patients. Villous tumors consisting of villous adenoma (21 lesions) and villotubular adenoma (26 lesions) were classified into three types (pedunculated, sessile and plaqueike types) based on their macroscopic findings.

　Pedunculated type was observed more often than the other two and as large as at least 1 cm in diameter. A stalk of the tumor was demonstrated by double contrast barium enema in 92% of the lesions. Sessile type was larger than 0.6 cm in diameter and the one with mucosal cancer, larger than 2 cm in diameter. This type was demonstrated as tumor with nodular surface by radiology.

　Plaque-like type was larger than 2 cm in diameter and the one with mucosal cancer, larger than 4 cm in diameter. Barium enema showed this type as reticular or nodular pattern.

　Radiographic picture of a colorectal tumor with nodular surface or shaggy margin was very helpful in diagnosing villous tumor larger than 2. 0 cm in diameter.