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Stomach and Intestine(Tokyo) Volume 42, Issue 3 （March 2007）

胃と腸 42巻3号（2007年3月発行）

Japanese English

今月の主題大腸鋸歯状病変の発育進展と診断・取り扱い

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大腸鋸歯状病変の発生と発育進展―発育進展―鋸歯状腺腫と過形成性ポリープの癌化 Cancer Progression of Hyperplastic Polyps and Serrated Adenomas of the Colorectum 原岡誠司 ¹ , 岩下明徳 ¹ , 太田敦子 ¹ Seiji Haraoka ¹ , Akinori Iwashita ¹ , Atsuko Ohta ¹ ¹福岡大学筑紫病院病理部 ¹Department of Pathology, Chikushi Hospital, Fukuoka University, Chikushino, Japan キーワード： serrated adenoma , hyperplastic polyp , 癌化 , cytokeratin , 粘液形質 Keyword: serrated adenoma , hyperplastic polyp , 癌化 , cytokeratin , 粘液形質 pp.288-298

発行日 2007年3月25日 Published Date 2007/3/25

DOI https://doi.org/10.11477/mf.1403100966

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要旨　癌を合併した鋸歯状腺腫（SA）14病変および癌を合併した過形成性ポリープ（HP）11病変について，臨床病理学的に検討した．発生部位は癌合併SAの64％，癌合併HPの80％が盲腸～横行結腸であり，右側結腸に多くみられ，病変の大きさは両者ともに平均16mmであった．肉眼形態は癌合併SAは有茎性隆起が多く，癌合併HPでは無茎性隆起が多かった．癌の多くは粘膜内に限局する高分化腺癌で，SA成分やHP成分より構成割合の少ない病変が多く認められた．免疫組織学的にcytokeratin（CK）7は，癌合併SAにおけるSAで35.7％，癌部で50％に陽性であり，癌合併HPではHPで27.3％，癌部では36.4％が陽性であった．特に癌合併SAにおける癌部の50％はCK7＋/CK20＋であった．癌を合併するSAおよびHPにおけるCK7の発現頻度は癌病巣で最も高く，次いでSA，HPという傾向がみられた．粘液形質の発現については混合型（胃腺窩上皮型＋腸型）粘液形質の発現（MUC5AC＋/MUC2＋）を示すものが，癌合併SAにおけるSAで78.6％，癌部は42.9％，癌合併HPのHPは全病変で，その癌部では90.9％を占めた．癌合併SA病変において胃型粘液形質を発現する頻度は高く，癌合併HP病変においてはその多くがHP，癌成分ともに胃型粘液形質を発現していた．以上より，SAおよびHPに合併する癌は，通常の大腸癌とは異なる，併存病変に類似した免疫組織学的特徴を有するものがあり，SAおよびHPは一部の大腸癌の前駆病変であることが示唆された．

　A clinicopathological study of 14 serrated adenomas (SA) with carcinoma (CA) and 11 hyperplastic polyps (HP) with carcinoma of the large intestine was carried out. 64％ of SA with CA and 80％ of HP with CA were located in the caecum, ascending colon, and transverse colon and they were frequently observed in the right-sided colon rather than in the left-sided colon. The average largest diameter of SA with CA and HP with CA was approximately 16mm. As for the macroscopic features of SA with CA, there were many pedunculated and subpedunculated elevated lesions, and there were many sessile elevated lesions in HP with CA. Most of the CA components were intramucosal, well differentiated adenocarcinoma, and the proportion of CA component was mostly less than that of HP and SA in their respective lesions. Immunohistochemically, the cytokeratin 7(CK7)-positive rate was as follows ; 35.7％ of SAs and 50％ of CAs in the SA with CA group, and 27.3％ of HPs and 36.4％ of CAs in the HP with CA group. The CK7 expression was more frequent in CA than in SA and HP. 50％ of CAs in the SA with CA group presented a CK7＋/CK20＋ pattern. Concerning the expression of the human apomucins, in the SA with CA group, the mixed mucinous phenotype combining both gastric foveolar and intestinal mucin (MUC5AC＋/MUC2＋) was 78.6％ of SA and 42.9％ of CA, and all of the HP and 90.9％ of CA were mixed phenotype in the HP with CA group. The expression of gastric mucin was increased in the SA with CA group, and most of the lesions in the HP with CA group expressed the gastric mucin. In conclusion, the carcinomas accompanied by SA and HP have immunohistochemical characteristics which were similar to those of SA and HP, and were different from those of common colorectal carcinomas. The present results suggest that SA and HP are the precursor lesions of some colorectal carcinomas.