大腸内分泌細胞癌の臨床病理学的検討

Clinicopathological Characteristics of Colorectal Endocrine Cell Carcinoma

要旨●2001年〜2015年の間に，当院で経験した大腸内分泌細胞癌18例を臨床病理学的に検討した．筆者らが経験した症例は腫瘍の厚みがある2型もしくは3型の腫瘍で，内分泌細胞癌成分は腫瘍深部や潰瘍底に存在していた．生検で未分化成分を検出した症例が多いが，合併する腺癌の比率で，生検による術前診断は困難と考えられる症例も存在した．腫瘍内の内分泌細胞癌成分の量の違いは臨床病理学的特徴や予後を反映せず，内分泌細胞癌成分が少量であっても同様に予後不良であった．近年，集学的治療による予後改善が試みられており，治療方針を決定するうえで術前診断は重要である．深部浸潤傾向が強い症例や生検で未分化成分を伴う症例は本疾患も念頭に置いて検査を進める必要がある．

　We investigated 18 patients with colorectal endocrine cell carcinoma who were treated at our hospital between 2001 and 2015. The patients had either type 2 or 3 thick, ulcerogenic tumors with carcinoma components in the deep regions of tumors and ulcer floors. Although undifferentiated carcinoma components were found on biopsy in many of the patients, a preoperative diagnosis on the basis of biopsy was considered difficult in some patients because of their disease stage at diagnosis or the percentage of adenocarcinoma cells. Clinicopathological characteristics and prognoses did not reveal any difference in the amount of endocrine cell carcinoma components in the patients' tumors. The prognosis of the disease was poor regardless of the amount of endocrine cell carcinoma components. Multidisciplinary treatment approaches have been recently attempted for improving the prognosis ; a preoperative diagnosis is considered important in deciding treatment courses. Examinations should be performed with colorectal endocrine cell carcinoma in mind when undifferentiated carcinoma components are found on biopsy or a tendency of deep infiltration is suggested.