潰瘍性大腸炎に合併する大腸癌・dysplasiaの肉眼・実体顕微鏡像と生検組織診断

Ulcerative Colitis-associated Dysplasia and Carcinoma: With Special Reference to Their Macroscopic and Stereomicroscopic Characteristics and Histological Diagnosis

要旨　潰瘍性大腸炎（UC）に合併したdysplasia（粘膜内上皮性腫瘍：粘膜内癌を含む）を中心に，その肉眼像，実体顕微鏡観察下の微細表面性状を検討し，生検組織診断について考察した．dysplasiaは肉眼的には，45.8％（11/24）が隆起であり，褐色～黄褐色調を呈するものが19/24（79.2％）を占めた．pit patternの大部分はIBD非合併大腸粘膜にみられる腺腫，粘膜内癌のそれらと類似していた．dysplasiaの多くは，内科的治療によりUCを寛解期に導入したうえで，隆起もしくは発赤に注目し，同部のpit patternを観察することで内視鏡的に捉えることが可能であると考えられた．UC粘膜の生検組織診断に際しては，dysplasiaと炎症（再生）異型，UC粘膜内に発生した通常型腺腫との鑑別が問題となる．これらの鑑別には，病理学的にはp53免疫染色が有用な補助手段となりうると考えられた．

　Macroscopic and stereomicroscopic characteristics of UC-associated neoplasias (especially dysplasias) were studied, and their histological diagnosis by biopsy specimens was discussed. Macroscopically. 45.8% (11/24) of dysplasias were elevated lesions and their color was brownish to yellowish brown in 79.2% (16/24). Pit patterns observed by stereomicroscopy of dysplasias and carcinomas in UC were similar to those seen in sporadic adenomas and carcinomas of the colon and rectum. UC-associated neoplasias are likely to be found endoscopically by elevation or redness and diagnosed as neoplasias through the observation of their pit patterns. This endoscopic procedure must be followed by clinical medication. Until the remission phase of UC is induced. For the histological diagnosis of bioppy specimens, p 53 immunostaining was considered to be a helpful method for making a precise differential diagnosis of dysplasia (or carcinoma) distinguishing it from atypical epithelium due to inflammatory or regenerating changes, and from sporadic adenoma coincidentally coriiplicating UC.