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Stomach and Intestine(Tokyo) Volume 49, Issue 10 （September 2014）

胃と腸 49巻10号（2014年9月発行）

Japanese English

今月の主題 colitic cancerの初期病変─遡及例の検討を含めて

colitic cancer遡及例の全国アンケート調査

潰瘍性大腸炎に伴うcolitic cancerの発育進展―遡及例からみた初期病変推定とその形態変化 Development of Colitic Cancer Associated with Ulcerative Colitis: Retrospective Endoscopic Analysis for Earlier Lesion and its Growth Speed 松井敏幸 ¹ , 山崎一朋 ¹ , 久部高司 ¹ , 青見賢明 ¹ , 諸隈強 ¹ , 矢野豊 ¹ , 高木靖寛 ¹ , 平井郁仁 ¹ , 岩下明德 ² , 岩男泰 ³ , 松本主之 ⁴ , 大井秀久 ⁵ , 安藤朗 ⁶ , 江崎幹宏 ⁷ , 青柳邦彦 ⁸ , 杉田昭 ⁹ , 仲瀬裕志 ¹⁰ , 藤谷幹浩 ¹¹ , 田中信治 ¹² , 清水誠治 ¹³ , 国崎玲子 ¹⁴ , 飯塚文瑛 ¹⁵ , 春間賢 ¹⁶ Toshiyuki Matsui ¹ , Kazutomo Yamasaki ¹ , Takashi Hisabe ¹ , Yoshiaki Aomi ¹ , Tsuyoshi Morokuma ¹ , Yutaka Yano ¹ , Yasuhiro Takaki ¹ , Fumihito Hirai ¹ , Akinori Iwashita ² , Yasushi Iwao ³ , Takayuki Matsumoto ⁴ , Hidehisa Ohi ⁵ , Akira Ando ⁶ , Motohiro Esaki ⁷ , Kunihiko Aoyagi ⁸ , Akira Sugita ⁹ , Hiroshi Nakase ¹⁰ , Mikihiro Fujiya ¹¹ , Shinji Tanaka ¹² , Seiji Shimizu ¹³ , Reiko Kunisaki ¹⁴ , Bunei Iizuka ¹⁵ , Ken Haruma ¹⁶ ¹福岡大学筑紫病院消化器内科 ²福岡大学筑紫病院病理部 ³慶應義塾大学病院予防医療センター ⁴岩手医科大学医学部内科学講座消化器内科消化管分野 ⁵慈愛会今村病院消化器内科 ⁶滋賀医科大学消化器内科 ⁷九州大学大学院病態機能内科学 ⁸福岡大学医学部消化器内科 ⁹横浜市立市民病院炎症性腸疾患センター ¹⁰京都大学大学院医学研究科消化器内科 ¹¹旭川医科大学内科学講座消化器・血液腫瘍制御内科学分野 ¹²広島大学病院内視鏡診療科 ¹³大阪鉄道病院消化器内科 ¹⁴横浜市立大学付属市民総合医療センター炎症性腸疾患センター ¹⁵東京女子医科大学消化器内科 ¹⁶川崎医科大学消化管内科学 ¹Department of Gastroenterology, Fukuoka University Chikushi Hospital, Chikushino, Japan ²Department of Pathology, Fukuoka University, Chikushi Hospital, Chikushino, Japan ³Center for Preventive Medicine, Keio University School of Medicine, Tokyo ⁴Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, School of Medicine, Morioka, Japan ⁵Department of Gastroenterology, Imamura Hospital, Kagoshima, Japan ⁶Division of Infectious Disease and Immunological Regulation, Major of Integrated Medical Science, Shiga University of Medical Science, Otsu, Japan ⁷Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ⁸Department of Gastroenterology and Medicine, Fukuoka University School of Medicine, Fukuoka, Japan ⁹Department of Surgery, Yokohama Municipal Hospital, Yokohama, Japan ¹⁰Department of Gastroenterology and Hepatology, Endoscopic Medicine, Kyoto University Hospital, Kyoto, Japan ¹¹Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan ¹²Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan ¹³Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, Osaka, Japan ¹⁴Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo ¹⁵Inflammatory Bowel Disease Center, Yokohama City University Medical Center Yokohama, Japan ¹⁶Division of Gastroenterology Department of Internal Medicine, Kawasaki Medical school, Kurashiki, Japan キーワード：潰瘍性大腸炎 , colitic cancer , 初期病変 , 発育進展 Keyword: 潰瘍性大腸炎 , colitic cancer , 初期病変 , 発育進展 pp.1517-1532

発行日 2014年9月25日 Published Date 2014/9/25

DOI https://doi.org/10.11477/mf.1403114276

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要旨　全国アンケート調査により潰瘍性大腸炎（UC）に伴う大腸癌の初期病変形態を推定し，その進展と形態変化ならびに発育速度を推定することを目的とした．対象は，初期病変が内視鏡撮影され，最終的に切除され病理学的検査が十分に行われた54病変49例で，腫瘍発見時年齢は平均50.5歳，罹病期間平均15.9年．病変部位はS状結腸と直腸に43病変（79.6％）．初回病変の内訳は，内視鏡的に腫瘍と認識可能な22病変（40.7％）では，隆起18病変（IIa 12，IIa＋IIc 2，Is 3，Is＋IIb 1）と陥凹（IIc 3，IIc＋IIb 1）4病変（18.2％）より成り，腫瘍と認識不可能な32病変（59.3％）では，活動期粘膜20病変と寛解期粘膜12病変であった．最終的に進行癌であったものが19病変（観察期間32.8か月）で，最終的に早期癌（あるいはdysplasia）35病変（観察期間38.6か月）に分けられた．最終病変は隆起39病変，平坦・陥凹5病変と狭窄10病変であった．進行癌の発育形式は，管腔狭窄（42.1％）や隆起が増大（100％）することが多かった．早期癌の発育形式は，隆起増大ないし隆起形成例が68.6％を占めた．初回病変が3年以内に進行癌となった急速発育例が進行癌の68.4％（13/19）を占め，全癌では24.1％であった．結論としてUCに伴う癌の初期像は約3年前の検査で40％が認識されえたが，60％は炎症粘膜と判定されていた．早期の腫瘍発見には，炎症粘膜からの積極的な生検が必要であり，腫瘍が比較的短時間に発育することも念頭に置いたサーベイランス策定が望まれる．

　We conducted a retrospective multi-institutional questionnaire survey of 49 UC（ulcerative colitis）patients with UC-associated CRN（colorectal neoplasia）. The aim of the study was to assess the progression of tumor（configuration change and growth speed）. The 49 subjects（mean age＝50.5years ; mean time since diagnosis＝15.9years）had a total of 54 lesions. Endoscopic features of all lesions had been documented within four years before the final examination and all the resected specimens were pathologically examined. On initial endoscopy, 22 lesions had been diagnosed as neoplasia. Of these, 18（33.3％）were elevated and four（7.4％）were depressed lesions. Thirty-two lesions, located in the recto-sigmoid region, had been diagnosed as non-neoplastic on initial endoscopy. Of these 20（37.0％）were active UC mucosa and 12（22.2％）were remission UC mucosa. On final examination, 19 lesions were classified as advanced cancer（observation period since initial endoscopy＝32.8months）and 35 lesions were early stage CRN（observation period since initial endoscopy＝38.6months）. Lesions classified as advanced cancer had progressed into luminal stenosis（42.1％）by tumor enlargement（100％）. Early CRN lesions had progressed by tumor enlargement（68.6％）. Rapid growing cancer which grew up into advanced cancer within three years was observed in 68.4％ of advanced cancer cases and 24.1％ of all CRN cases.

　Conclusions : This retrospective study of patients with UC-associated CRN showed that on initial endoscopy, 40％ of lesions were diagnosed as neoplasia but 60％ were diagnosed as non-neoplastic inflamed UC mucosa. To detect earlier CRN by surveillance endoscopy, random biopsy appears to be indispensable and it should be better to modulate surveillance program to detect rapid growing tumor which comprised 25％ of CRN.