胃と腸46巻4号

2011年04月発行

今月の主題 大腸鋸歯状病変と癌化 主題

大腸鋸歯状病変の臨床病理学的特徴および分子病理学的意義

著者： 菅井有¹ 山野泰穂² 木村友昭² 山本栄一郎³ 豊田実³ 鈴木一幸⁴

所属機関： ¹岩手医科大学医学部病理学講座分子診断病理学分野 ²秋田日赤病院消化器病センター ³札幌医科大学医学部生化学講座 ⁴札幌医科大学医学部内科学講座消化器肝臓内科分野

ページ範囲：P.373 - P.383

要旨　鋸歯状ポリープは，過形成性ポリープ，鋸歯状腺腫，SSA/P（sessile serrated adenoma/polyp），混合型ポリープに分類されるのが一般的である．これらのポリープの病理診断は，本邦ではいまだ一定のコンセンサスを得るには至っていないが，特にSSA/Pの診断の混乱は目立っている．SSA/Pの病理組織像の特徴は，（1）腺管底部のL字状所見，逆T字状所見，（2）腺管の拡張，（3）不規則な分岐像，などである．このポリープの分子発生メカニズムは，BRAF変異，CIMP（CpG islands methylation phenotype）-high，MSI（microsatellite instability）で特徴づけられる．一方ki-ras変異，CIMP-low，MSS（microsatellite stable）と密接に関連している別経路も指摘されている．鋸歯状ポリープの最終的な病変はMSI陽性大腸癌とされてきたが，近年の検討で，MSS癌の場合もあることが明らかになってきた．鋸歯状ポリープは臨床病理学的，分子病理学的にも従来のadenoma-carcinoma sequenceとは異なった経路である．

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