表面型（Ⅱ型）大腸上皮性腫瘍―10mm以上の平盤状隆起病変について

Colonic Epithelial Tumors as Flat Elevated Lesions (Ⅱ Type): Larger Than 10 mm in Size

要旨　10mm以上の平盤状隆起を呈した64例70病変について検討し，以下の結果を得た．性別では男性41例（64％），女性23例（36％），年齢は41から88歳までで，平均年齢は64.4歳であった．発見頻度は注腸X線検査の0.75％であった．肉眼形態（長谷川らの分類に準じた）は，ポリープ集簇型36病変（51％），中心くびれ型20病変（29％），中心陥凹型8病変（11％），平坦型6病変（9％）であった．組織型は，腺腫42病変（60％），癌21病変（30％），化生性ポリープなど7病変（10％）であった．中心陥凹型に癌が多く（75％），平坦型はすべて良性であったが，他の2型は良・悪性の鑑別は困難であった．X線検査で発見されたものは46病変（67％）で，X線検査の描出能は84％であった．内視鏡所見では発赤を16病変（27％）に認めたが，良・悪性との関連はなかった．処置は手術37病変（53％），ポリペクトミー13病変（18％），生検（経過観察）20病変（29％）であった．

　Seventy colonic flat elevated lesions (FEL) more than 10 mm in diameter were investigated macroscopically and histologically in 64 patients. There were 41 men and 23 women, ranging in age from 41-88 (mean, 64.4 years). FEL were found in 16 cases of 2,137 barium enema examinations (prevalence 0.75%) during the past three years period.

　According to a modified Hasegawa's classification system, FEL were macroscopically classified into four groups; smooth FEL (9%), FEL with incision (29%), conglomerated Ⅱa-like (51%) and FEL with central depression (11%).

　Histologically, FEL were classified into three types; carcinoma (30%), adenoma (60%) and non-neoplastic tumor (10%). Seventry five percent of FEL with central depression were carcinoma, and all of the smooth FEL were adenomas or non-neoplastic tumors. No evaluations were made concerning the other two macroscopical groups, viz. FEL with incision and conglomerated Ⅱa-like tumors.

　Fifty eight lesions (84%) of FEL were detected by barium enema. Endoscopically, superficial redness was observed in 16 lesions (27%) of FEL. However this finding was not helpful to differentiate adenoma and carcinoma.

　As treatment for FEL, surgery, polypectomy and biopsy were performed. Percentage of each method was 53%, 18% and 29%, respectively.