胃と腸50巻13号

2015年12月発行

今月の主題 大腸鋸歯状病変の取り扱い

主題

大腸鋸歯状病変の病理診断

著者： 三富弘之¹² 田中大貴¹ 山岸秀嗣³ 五十嵐誠治⁴ 平林かおる⁴ 大倉康男⁵ 伴慎一⁶ 岩渕三哉⁷ 新井冨生⁸ 九嶋亮治⁹ 河内洋¹⁰ 和田了¹¹ 八尾隆史²

所属機関： ¹関東労災病院病理診断科 ²順天堂大学医学部人体病理病態学講座 ³獨協医科大学病院病理診断科 ⁴栃木県立がんセンター臨床検査部病理診断科 ⁵杏林大学医学部病理学教室 ⁶獨協医科大学越谷病院病理診断科 ⁷新潟大学医学部保健学科検査技術科学専攻 ⁸東京都健康長寿医療センター病理診断科 ⁹滋賀医科大学医学部臨床検査医学講座（病理診断科） ¹⁰がん研有明病院臨床病理センター病理部 ¹¹順天堂大学医学部附属静岡病院病理診断科

ページ範囲：P.1636 - P.1647

文献概要

要旨●鋸歯状病変については，最新のWHO分類で用語の統一がなされたが，その診断一致率は低く，それらに対する適切な臨床対応やserrated neoplasia pathwayの前癌病変を抽出するため，その正確な組織診断の必要性が増している．そこで，9名の消化管疾患専門病理医による12個の鋸歯状病変の組織診断の差異とその要因について分析した．その結果，右半結腸の無茎性鋸歯状腺腫/ポリープ（SSA/P）の診断一致率は高く，その診断には主に陰窩底部の拡張，陰窩底部の分岐，陰窩底部の水平方向への変形，陰窩底部からの鋸歯状変化が抽出されていたこと，左半結腸の有茎性SSA/Pは古典的鋸歯状腺腫（TSA）と診断されることが多いことが明らかとなった．また，TSAの診断に対するBRAF免疫組織化学染色の有用性も合わせて紹介した．

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