胃と腸48巻8号

2013年07月発行

今月の主題 非腫瘍性大腸ポリープのすべて

主題

大腸過形成ポリープ―病理診断の立場から

著者： 八尾隆史¹ 森本崇¹² 村上敬¹²

所属機関： ¹順天堂大学大学院医学研究科人体病理病態学 ²順天堂大学大学院医学部消化器内科

ページ範囲：P.1111 - P.1117

文献概要

要旨　大腸鋸歯状病変は現在のWHO分類（2010）では，（1）過形成ポリープ（hyperplastic polyp ; HP），（2）鋸歯状腺腫（traditional serrated adenoma ; TSA），（3）広基性鋸歯状腺腫/ポリープ（sessile serrated adenoma/polyp ; SSA/P）に分類され，さらにHPはMVHP（microvesicular HP），GCHP（goblet cell-rich HP），MPHP（mucin-poor HP）の3型に亜分類されている．HPは男性に多く，S状結腸・直腸に好発する5mm以下の扁平隆起であり，癌化の危険はないと考えられているが，MVHPは高率にBRAF遺伝子変異を伴いSSA/Pの前駆病変と考えられ，GCHPはK-ras遺伝子変異をしばしば伴うが腺腫や癌との関連は不明である．MPHPはまれでありMVHPや腺腫に再生性変化が加わったものと考えられている．なお，過形成/鋸歯状ポリポーシスは癌化の高危険群と認識しておく必要がある．

参考文献

1）Bosman FT, Carneiro F, Hurban RH, et al（eds）. WHO classification of Tumours of the Digestive System. IARC Press, Lyon, 2010

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

3）Gibbs NM, Katz D. Hyperplastic polyps（synonym : metaplastic polyps）. In Morson BC（ed）.The Pathogenesis of Colorectal Cancer. WB Saunders, Philadelphia, pp 14-20, 1978

4）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

5）Torlakovic E, Snover DC. Serrated adenomatous polyposis in humans. Gastroenterology 110 : 748-755, 1996

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

7）Clouston AD, Walder NI. Polyps and tumour-like lesions of the large intestinie. In Shepherd NA, Warren BF, Williams GT, et al（eds）. Morson and Dawson's Gastrointestinal pathology, 5th ed. Wiley-Blackwell, pp 656-664, 2013

8）Lu F-I, van Niekerk DW, Owen D, et al. Longitudinal outcome study of sessile serrated adenomas of the colorectum : an increased risk for subsequent right-sided colorectal carcinoma. Am J Surg Pathol 34 : 927-934, 2010

9）Williams GT, Arthur JF, Bussey HJ, et al. Metaplastic polyps and polyposis of the colorectum. Histopathology 4 : 155-170, 1984

10）Frazin G, Zamboni G, Scarpa A, et al. Hyperplastic（metaplastic）polyps of the colon. A histologic and histochemical study. Am J Surg Pathol 8 : 687-698, 1980

11）Kaye GI, Fenoglio CM, Pascal RR, et al. Comparative electron microscopic features of normal, hyperplastic, and adenomatous human colonic epithelium. Variations in cellular structure relative to the process of epithelial differentiation. Gastroenterology 64 : 926-945, 1973

12）Hayashi T, Yatani R, Apostol J, et al. Pathogenesis of hyperplastic polyps of the colon : a hypothesis based on ultrastructure and in vitro cell kinetics. Gastroenterology 66 : 347-356, 1974

13）Jass JR, Filipe MI, Abbas S, et al. A morphologic and histochemical study of metaplastic polyps of the colorectum. Cancer 53 : 510-515, 1984

14）Biemer-Hüttmann AE, Walsh MD, McGuckin MA, et al. Immunohistochemical staining patterns of MUC1, MUC2, MUC4, and MUC5AC mucins, in hyperplastic polyps, serrated adenomas, and traditional adenomas of the colorectum. J Histochem Cytochem 47 : 1039-1047, 1999

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

16）Hirono H, Ajioka Y, Watanabe H, et al. Bidirectional gastric differentiation in cellular mucin phenotype（foveolar and pyloric）in serrated adenoma and hyperplastic polyp of the colorectum. Pathol Int 54 : 401-407, 2004

17）Jass JR, Baker K, Zlobec I, et al. Advanced colorectal polyps with the molecular and morphological features of serrated polyps and adenomas : concept of a‘fusion'pathway to colorectal cancer. Histopathology 49 : 121-131, 2006

18）O'Brien MJ, Yang S, Mack C, et al. Comparison of microsatellite instability, CpG island methylation phenotype, BRAF and KRAS status in serrated polyps and traditional adenomas indicates separate pathways to distinct colorectal carcinoma end points. Am J Surg Pathol 30 : 1491-1501, 2006

19）Spring KJ, Zhao ZZ, Karamatic R, et al. High prevalence of sessile serrated adenomas with BRAF mutations : a prospective study of patients undergoing colonoscopy. Gastroenterology 131 : 1400-1407, 2006

20）Carr NJ, Mahajan H, Tan KL, et al. Serrated and non-serrated polyps of the colorectum : their prevalence in an unselected case series and correlation of BRAF mutation analysis with the diagnosis of sessile serrated adenoma. J Clin Pathol 62 : 516-518, 2009

21）Kim KM, Lee EJ, Ha S, et al. Molecular features of colorectal hyperplastic polyps and sessile serrated adenoma/polyps from Korea. Am J Surg Pathol 35 : 1274-1286, 2011

22）Jass JR, Whitehall VL, Young J, et al. Emerging concepts in colorectal neoplasia. Gastroenterology 123 : 862-876, 2002

23）Torlakovic EE, Gomez JD, Driman DK, et al. Sessile serrated adenoma（SSA）vs. traditional serrated adenoma（TSA）. Am J Surg Pathol 32 : 21-29, 2008

24）八尾隆史，菅井有，岩下　明德，他．大腸SSA/Pの病理組織学的特徴と診断基準（大腸癌研究会プロジェクト研究から）．胃と腸 46 : 442-448，2011

25）Leggett BA, Devereaux B, Biden K, et al. Hyperplastic polyposis. Association with colorectal cancer. Am J Surg Pathol 25 : 177-184, 2001

26）Yao T, Nishiyama K, Oya M, et al. Multiple‘serrated adenocarcinomas'of the colon with a cell lineage common to metaplastic polyp and serrated adenoma. Case report of a new subtype of colonic adenocarcinoma with gastric differentiation. J Pathol 190 : 444-449, 2000