胃と腸43巻13号

2008年12月発行

今月の主題 大腸癌の発生・発育進展 主題

大腸癌の発育進展における大腸鋸歯状病変の意義―早期大腸癌に合併する大腸鋸歯状病変の臨床病理学的検討

著者： 江頭由太郎¹ 芥川寛¹ 枝川豪¹ 藤井基嗣¹ 川上研² 阿倍洋介² 村野実之² 樋口和秀²

所属機関： ¹大阪医科大学病理学教室 ²大阪医科大学第2内科学教室

ページ範囲：P.1911 - P.1923

要旨　早期大腸癌604病変（M癌300病変，SM癌304病変）を対象に，大腸癌の発育進展における鋸歯状病変の意義を検討した．鋸歯状病変はHP，SSP，TSA，SADに分類した．M癌においてHP ，SSP，TSA，SADの合併率はそれぞれ31.3％，2.0％，12.7％，5.3％であった．SM癌においてHP ，SSP，TSA，SADの合併率はそれぞれ43.4％，1.0％，9.2％，4.9％であった．SSP合併例は全例が右側大腸に存在し，TSA合併例は左側大腸に多かった．胃型形質は，SSP，TSAの鋸歯状病変部では全例に発現がみられたが，癌部では発現率が低下した．早期癌全体で，SSP，TSA，SADの少なくとも1つが合併した病変の頻度は13.9％であった．この値が鋸歯状病変由来の大腸癌の頻度に相当すると推測され，serrated pathwayは大腸癌の発育進展において無視できない割合を占めると考えられた．しかし，大腸鋸歯状病変は用語の統一や診断基準の確立などの解決されていない問題点を残しており，さらなる検証が必要である．

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