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

大腸鋸歯状病変の内視鏡診断―通常内視鏡所見を中心に

著者： 長谷川申¹² 鶴田修¹² 河野弘志¹² 有田桂子¹² 前山泰彦¹² 野田哲裕¹² 長田修一郎¹² 光山慶一¹² 佐田通夫¹²

所属機関： ¹久留米大学医学部内科学講座消化器内科部門 ²久留米大学医学部消化器病センター

ページ範囲：P.394 - P.404

要旨　現時点では大腸鋸歯状病変の病理分類はHP（hyperplastic polyp），SSA/P（sessile serrated adenoma/polyp），TSA（traditional serrated adenoma）と大きく3つのカテゴリーに分類するのが一般的である．特にSSA/Pは右側結腸のMSI陽性大腸癌の前駆病変として現在注目されている病変であり，内視鏡における大腸鋸歯状病変の診断意義は高い．筆者らの検討では，通常観察においての3者の鑑別点として病変の局在，大きさ，肉眼形態が挙げられた．すなわちSSA/PはHP，TSAに比して有意に右側結腸に多く，SSA/PとTSAはいずれも10mm以上でHPに比して優位に大きかった．またTSAはHP，SSA/Pに比して松毬様所見と二段隆起所見が有意に多く認められた．

参考文献

1）Morson BC. Precancerous and early malignant lesions of the large intestine. Br J Surg 55 : 725-731, 1968

2）Muto T, Bussey HJ, Morson BC. The evolution of cancer of the colon and rectum. Cancer 36 : 2251-2270, 1975

3）藤田幹夫，藤井茂彦，富永圭一，他．大腸癌の発生・進展─分子生物学からみた大腸癌発生．消外 28 : 585-592, 2005

4）中村恭一．大腸癌の構造．医学書院，pp 37-50，1989

5）Spratt JS Jr, Ackerman LV, Moyer CA. Relationship of polyps of the colon to colonic cancer. Ann Surg 148 : 682-696, 1958

6）Kambara T, Simms LA, Whitehall VL, et al. BRAF mutation is associated with DNA methylation in serrated polyps and cancers of the colorectum. Gut 53 : 1137-1144, 2004

7）Jass JR. Serrated adenoma of the colorectum and the DNA-methylator phenotype. Nat Clin Pract Oncol 2 : 398-405, 2005

8）O'Brien MJ. Hyperplastic and serrated polyps of the colorectum. Gastroenterol Clin North Am 36 : 947-968, 2007

9）Torlakovic E, Skovlund E, Snover DC, et al. Morphologic reappraisal of serrated colorectal polyps. Am J Surg Pathol 27 : 65-81, 2003

10）Jass JR. Serrated route to colorectal cancer : back street or super highway ? J Pathol 193 : 283-285, 2001

11）Jass JR. Classification of colorectal cancer based on correlation of clinical, morphological and molecular features. Histopathology 50 : 113-130, 2007

12）Cunningham KS, Riddell RH. Serrated mucosal lesions of the colorectum. Curr Opin Gastroenterol 22 : 48-53, 2006

13）Morson BC. Some peculiarities in the histology of intestinal polyps. Dis Colon Rectum 5 : 337-344, 1962

14）Higuchi T, Sugihara K, Jass JR. Demographic and pathological characteristics of serrated polyps of colorectum. Histopathology 47 : 32-40, 2005

15）Urbanski SJ, Kossakowska AE, Marcon N, et al. Mixed hyperplastic adenomatous polyps─an underdiagnosed entity. Report of a case of adenocarcinoma arising within a mixed hyperplastic adenomatous polyp. Am J Surg Pathol 8 : 551-556, 1984

16）Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 14 : 524-537, 1990

17）Johnson DA, Gurney MS, Volpe RJ, et al. A prospective study of the prevalence of colonic neoplasms in asymptomatic patients with an age-related risk. Am J Gastroenterol 85 : 969-974, 1990

18）DiSario JA, Foutch PG, Mai HD, et al. Prevalence and malignant potential of colorectal polyps in asymptomatic, average-risk men. Am J Gastroenterol 86 : 941-945, 1991

19）Imperiale TF, Wagner DR, Lin CY, et al. Results of screening colonoscopy among persons 40 to 49 years of age. N Engl J Med 346 : 1781-1785, 2002

20）Imperiale TF, Wagner DR, Lin CY, et al. Risk of advanced proximal neoplasms in asymptomatic adults according to the distal colorectal findings. N Engl J Med 343 : 169-174, 2000

21）Lieberman DA, Prindiville S, Weiss DG, et al. Risk factors for advanced colonic neoplasia and hyperplastic polyps in asymptomatic individuals. JAMA 290 : 2959-2967, 2003

22）Fenoglio CM, Kaye GI, Pascal RR, et al. Defining the precursor tissue of ordinary large bowel carcinoma : implications for cancer prevention. Pathol Annu 12Pt 1 : 87-116, 1977

23）Waye JD, Bilotta JJ. Rectal hyperplastic polyps : now you see them, now you don't─a differential point. Am J Gastroenterol 85 : 1557-1559, 1990

24）Batts KP. Serrated colorectal polyps : an update. Pathology Case Reviews 9 : 173-182, 2004

25）Jass JR. Hyperplastic-like polyps as precursors of microsatellite-unstable colorectal cancer. Am J Clin Pathol 119 : 773-775, 2003

26）Ajioka Y, Watanabe H, Jass JR, et al. Infrequent K-ras codon 12 mutation in serrated adenomas of human colorectum. Gut 42 : 680-684, 1998

27）O'Brien MJ, Yang S, Clebanoff JL, et al. Hyperplastic（serrated）polyps of the colorectum : relationship of CpG island methylator phenotype and K-ras mutation to location and histologic subtype. Am J Surg Pathol 28 : 423-434, 2004

28）Yang S, Farraye FA, Mack C, et al. BRAF and KRAS mutations in hyperplastic polyps and serrated adenomas of the colorectum : relationship to histology and CpG island methylation status. Am J Surg Pathol 28 : 1452-1459, 2004

29）Jorgensen H, Mogensen AM, Svendsen LB. Hyperplastic polyposis of the large bowel. Three cases and a review of the literature. Scand J Gastroenterol 31 : 825-830, 1996

30）Summer HW, Wasserman NF, McClain CJ. Giant hyperplastic polyposis of the colon. Dig Dis Sci 26 : 85-89, 1981

31）Warner AS, Glick ME, Fogt F. Multiple large hyperplastic polyps of the colon coincident with adenocarcinoma. Am J Gastroenterol 89 : 123-125, 1994

32）Anderson JC, Pollack BJ. Predicting of hyperplastic histology by endoscopic features. Gastrointest Endosc 52 : 149-150, 2000

33）Rex DK, Rahmani EY. New endoscopic finding associated with hyperplastic polyps. Gastrointest Endosc 50 : 704-706, 1999

34）Rothstein RD, Kochman M. Large hyperplastic polyps of the right colon. Gastrointest Endosc 47 : 211-212, 1998

35）Langdon DE. Large hyperplastic polyps of the right colon. Gastrointest Endosc 48 : 659, 1998

36）Fenoglio-Preiser CM, Pascal RR, Perzin KH. Adenomas of the colon and rectum. In Atlas of tumor Pathology, 2nd Series, Fascicle 27, Tumors of the intestines. AFIP, Washington. DC, pp 76-150, 1990

37）久保起与子，加藤洋．Serrated Adenoma．病理と臨 15 : 292, 1997

38）嶋本文雄，田中信治，清水俊彦，他．Serrated adenomaの大腸分布からみた臨床病理学的特徴．第48回大腸癌研究会プログラム・抄録集．p 35，1998

39）岩下明徳，大重要人，山田豊，他．serrated adenomaの臨床病理学的検索．胃と腸 33 : 855-865, 1998

40）佐野寧，加藤茂治，目良清美，他．表面構造からみた大腸鋸歯状腺腫の質的診断の限界．消内視鏡 12 : 1113-1118, 2000

41）尾田恭，田中朋史，伊藤清治，他．大腸鋸歯状腺腫に対する通常内視鏡及び拡大内視鏡による表面構造の観察からの質的診断．消内視鏡 12 : 1119-1126, 2000

42）鶴田修，河野弘志，唐原健，他．大腸鋸歯状病変の臨床的取り扱い─私はこう考える．胃と腸 42 : 329-334, 2007

43）長谷川申，鶴田修，河野弘志，他．Sessile Serrated Adenoma/Polypの内視鏡診断．Gastroenterol Endosc 52（Suppl 1）: 911, 2010

44）岩渕正広，樋渡信夫，増田高行，他．大腸鋸歯状腺腫の診断─歴史的流れと現状での特性．消内視鏡 12 : 1077-1086, 2000

45）大江啓常，田中信治，日山亨，他．大腸鋸歯状腺腫の特徴─特に隆起型・表面型の相違を中心に．消内視鏡 12 : 1097-1105, 2000

46）Yao T, Kouzuki T, Kajiwara M, et al. Serrated' adenoma of the colorectum, with reference to its gastric differentiation and its malignant potential. J Pathol 187 : 511-517, 1999

47）Jass JR，Smith M. Sialic acid and epithelial differentiation in colorectal polyps and cancer-a morphological, mucin and lectin histochemical study. Pathology 24 : 233-242, 1992

48）Mäkinen MJ. Colorectal serrated adenocarcinoma．Histopathology 50 : 131-150, 2007

49）斎藤彰一，池上雅博，小野雅史，他．Serrated adenoma及びMixed hyperplastic adenomatous polypの臨床病理学的検討．Gastroenterol Endosc 40 : 12-21, 1998