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Stomach and Intestine(Tokyo) Volume 21, Issue 12 （December 1986）

胃と腸 21巻12号（1986年12月発行）

Japanese English

今月の主題大腸のvillous tumor

主題

大腸絨毛腫瘍（腺腫・早期癌）の内視鏡的検討 Endoscopic Study of Colonic Villous Tumors 長谷川かをり ¹ , 屋代庫人 ² , 長廻紘 ² Kaori Hasegawa ¹ , Kurato Yashiro ² , Kou Nagasako ² ¹東京女子医科大学第2病理 ²東京女子医科大学消化器病センター内科 ¹Department of Pathology, Tokyo Women's Medical College ²The Institute of Gastroenterology, Tokyo Women's Medical College pp.1325-1333

発行日 1986年12月25日 Published Date 1986/12/25

DOI https://doi.org/10.11477/mf.1403110059

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Abstract 文献概要
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要旨　1983年から1986年6月までにポリペクトミー，手術を行った652個の腺腫，早期癌を対象にtubular，villotubular，villousの3つの組織型別に発生頻度，癌化率を形，大きさの要素を加えて検討し，villous tumorと他の2つの亜型との相違をみた．それに従って内視鏡肉眼所見について検討した．villous tumorの定義はvillousの要素が80％以上占めるものとした．villous tumorは15個あり，腺腫・早期癌全体の2％を占めた．有茎，無茎性ともにその2％を占め，形による頻度の差はなかった．1例を除き直腸S状結腸に存在した．1cm以下のvillous tumorはなく，大きさが増すにつれてvillous tumorの頻度は増した．腺腫はすべてtubularとして生じ，発育のある時期に種々の程度にvillousの要素が加わることが推定された，villous tumorの頻度が高いのは2～3cmの有茎，4cm以上の広基性のグループであった．癌化率は80％で同じサイズでみた他の亜型より高く，特にsm癌の頻度が33％（villotubular 11％，tubular 8％）と高かった．手術の対象となるような大きな広基性腫瘍は内視鏡的にvillous tumorと診断することは容易であるが，それ以外のものでは他の亜型との鑑別診断は不可能であった．

　Six hundred and fifty-two polypectomized adenomas and early carcinomas were studied with respect to the proportion of three subtypes (tubular, villotubular and villous) of adenomas, rate of cancerization and their shape and size.

　Villous tumor was defined as the one that composed of more than 80% of villous gland. Fifteen tumors, 2% of all adenomas and early carcinomas, were classified in this category. Villous tumor was found in 2% of pedunculated and as many of sessile polyps. All but one villous tumors were located at the lower part of the large intestine (rectum and sigmoid colon).

　There were no villous polyps smaller than 1 cm in diameter. The proportion of villous polyps among adenomas increased with the size of polyps. Villous tumor was found with higher frequency in the following categories: 1) pedunculated polyp 2-3 cm in size, 2) sessile polyp larger than 4 cm in diameter.

　Eighty percent of villous tumors were malignant, the frequency of malignant change being the highest among the three subtypes. Thirty-three percent of villous tumors had submucosal invasion of carcinoma. This was again the highest among all subtypes of adenoma.

　Some villous tumors were identified endoscopically. Most smaller ones, especially pedunculated ones, however, showed no distinctive features and therefore it was impossible to differentiate them from other subtypes.