11年1か月の長期経過後にポリペクトミーしえた大腸腺管腺腫の1例

Tubular Adenoma of the Colon Re-evaluated after an 11-year-1-month Interruption of Follow-up, Report of a Case and an Analysis of the Data on Polypectomized Adenomas of the Colon

要旨　58歳，男性．下痢と下血を主訴に注腸X線，大腸内視鏡，生検の結果，S状結腸にGroup 3の腺管腺腫を認め，1年後の経過検査を勧めるもその後来院せず，11年1か月後に再び下血を訴え，注腸X腺・大腸内視鏡検査に続き内視鏡的ポリペクトミーを行い，未だGroup 3の腺管腺腫であった症例を経験したのでここに報告し，ポリペクトミー例におけるポリープの癌化について多少の考察を加えた．

　A 58-year-old male with complaints of diarrhea and melena underwent barium enema and endoscopic examination of the colon with biopsy. Histological diagnosis was a tubular adenoma of the colon, Group 3. Since then the patient did not visit us in spite of our recommendation to have follow-up examination one year later. Eleven year one months later, he developed melena again and barium enema, colonoscopy, and endoscopic polypectomy were performed. Histologically, the polypectomized lesion was still composed of tubular adenoma, 13 mm in longitudinal diameter.

　Data on polypectomized lesions obtained from the colon in our hospital were analyzed resulting in the following conclusions. 1) The larger in size of adenoma of the colon, the higher in grade of atypism, 2) 22 lesions of 26 early cancers of the colon were categorized as focal cancer in adenoma, suggesting malignant transformation of the adenomas, and 3) both adenomas and adenocarcinomas were most common in the sigmoid colon with the incidence rate for adenocarcinomas higher than that for adenoma.