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 主題研究

発生部位に基づいた大腸鋸歯状病変の臨床病理学的および分子病理学的検討

著者： 永塚真¹ 菅井有¹ 荒川典之¹ 高橋弥生¹ 杉本亮¹ 川崎啓祐² 梁井俊一² 中村昌太郎² 松下弘雄³ 山野泰穂³ 山本英一郎⁴ 鈴木拓⁴ 松本主之²

所属機関： ¹岩手医科大学医学部病理診断学講座 ²岩手医科大学医学部内科学講座消化器内科消化管分野 ³秋田赤十字病院消化器病センター ⁴札幌医科大学医学部分子生物学講座

ページ範囲：P.1709 - P.1722

要旨●左側と右側大腸間における大腸鋸歯状病変の臨床病理学的，分子遺伝学的検討を行った．対象として左側過形成性ポリープ（HP）27例，右側HP 18例，左側SSA/P 29例，右側SSA/P 32例を用いた．病理組織学的所見については陰窩の拡張，陰窩の分岐異常，陰窩腺底部の拡張・走行異常（腺底部の所見）の有無について検討した．MUC2，MUC5AC，MUC6，CD10，CDX-2，p53，MLH-1，MSH-2，MSH-6，PMS-2，ANNEXIN A10の発現を免疫組織化学的に検索した．分子解析はKRAS，BRAF変異解析とDNAメチル化解析を行った（高，中等度，低）．病理組織学的所見ではSSA/Pで腺底部の所見が右側で有意に多く，各因子の組み合わせパターンでは左側で陰窩の拡張と分岐異常のパターンが多く，右側では3因子すべてのパターンが多かった．MUC6およびANNEXIN A10の発現は右側のSSA/Pで有意に多くみられた．BRAFはSSA/Pで発生部位による違いはなかったが，メチル化では高メチル化状態が右側SSA/Pで高く，中等度メチル化と低メチル化状態が左側のSSA/Pで多かった．HPは左側でKRAS変異の頻度が高かった以外は左右の差異はなかった．SSA/Pでは発生部位によって組織像，分子異常が異なっている可能性が示唆された．

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