| 連載名 | 第24回大腸IIc研究会 優秀演題 | |
|---|---|---|
| 題名 | 多彩な拡大内視鏡所見を呈したSSA/P癌化症例 | |
| 発刊年月 | 2015年 11月 | |
| 著者 | 原田 英嗣 | 秋田赤十字病院消化器病センター／医療法人真誠会原田内科 |
| 著者 | 山野 泰穂 | 秋田赤十字病院消化器病センター |
| 著者 | 松下 弘雄 | 秋田赤十字病院消化器病センター |
| 著者 | 吉川 健二郎 | 秋田赤十字病院消化器病センター |
| 著者 | 高木 亮 | 秋田赤十字病院消化器病センター |
| 著者 | 青木 敬則 | 秋田赤十字病院消化器病センター |
| 著者 | 田中 義人 | 秋田赤十字病院消化器病センター |
| 著者 | 中岡 宙子 | 秋田赤十字病院消化器病センター |
| 著者 | 檜森 亮吾 | 秋田赤十字病院消化器病センター |
| 著者 | 永塚 真 | 秋田赤十字病院消化器病センター |
| 著者 | 吉田 優子 | 秋田赤十字病院消化器病センター |
| 著者 | 菅井 有 | 岩手医科大学病理診断学講座 |
| 著者 | 上杉 憲幸 | 岩手医科大学病理診断学講座 |
| 著者 | 山本 英一郎 | 札幌医科大学医学部消化器・免疫・リウマチ内科学講座／札幌医科大学医学部分子生物学講座 |
| 著者 | 鈴木 拓 | 札幌医科大学医学部分子生物学講座 |
| 【 要旨 】 | 症例は70歳代，女性，全大腸内視鏡検査施行で盲腸に約20mmの病変を指摘された．肉眼形態は二段隆起と高い隆起部に段差を伴う陥凹を有するIIa＋IIc病変であった．丈の低い隆起部は粘液付着が顕著であり，拡大観察では典型的な開II型pitを認めた．丈の高い隆起部辺縁は開II型様に類似するも管状様にもとれるpitであった．丈の高い隆起部中央の陥凹部周囲には管状様構造に歪さが目立つⅤI型pitを認め，陥凹内は一見無構造様だが角度によっては細かく密度の高い構造がわずかに感じられた．SSA/Pが基盤となり，cytological dysplasiaを経て，癌化した病変と考えられた．また陥凹部については病変の部位，成り立ちを加味し髄様癌の可能性を考えた．深達度は陥凹部でT1b（SM massive）の浸潤を疑ったが患者背景を考慮し，EMRを施行した． 病理結果はCarcinoma in SSA/P，Cancer：well to poorly differentiated adenocarcinoma（por1, medullary carcinoma），T1b（2,500μm），ly0，v0であった．多彩な拡大内視鏡所見が組織分化度の相違までを反映したSSA/P癌化症例と考え，遺伝子解析結果も加え報告した． |
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| Series | ||
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| Title | A case of carcinoma in sessile serrated adenoma / polyp with multiple endoscopic findings | |
| Author | Eiji Harada | Department of Gastroenterology, Akita Red Cross Hospital / Shinseikai Harada Clinic |
| Author | Hiro-o Yamano | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Hiro-o Matsushita | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Kenjiro Yoshikawa | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Ryo Takagi | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Hironori Aoki | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Yoshihito Tanaka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Michiko Nakaoka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Ryogo Himori | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Makoto Nagatsuka | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Yuko Yoshida | Department of Gastroenterology, Akita Red Cross Hospital |
| Author | Tamotsu Sugai | Department of Molecular Diagnostic Pathology, Iwate Medical University |
| Author | Noriyuki Uesugi | Department of Molecular Diagnostic Pathology, Iwate Medical University |
| Author | Eiichiro Yamamoto | DDepartment of Gastroenterology, Rheumatology and Clinical Immunology of Internal Medicine / Department of Molecular Biology, Sapporo Medical University |
| Author | Hiromu Suzuki | Department of Molecular Biology, Sapporo Medical University |
| [ Summary ] | We report on a case of carcinoma in a sessile serrated adenoma/polyp (SSA/P) in an elderly woman of approximately 70 years of age. The patient presented with a Type IIa+IIc lesion (20 mm in diameter that exhibited regions of high and low elevation, with a depression in the top of the highly elevated region in the cecum (the first section of the colon). Magnifying endoscopy indicated a Type II-open pit attern in regions of low elevation, Type Ⅱ-open/Type IIIL pit patterns in regions of high elevation, a Type VN pit pattern in the depression, and a Type VI pit pattern surrounding the depression, in which a small, tight structure could also be visualized, from a different angle. From these findings and background (e.g., location and structure), we diagnosed the lesion as a suspected Stage T1b carcinoma in SSA/P, with an additional, medullary carcinoma sited within the depression. In view of the patient's background, endoscopic mucosal resection was performed, and a histological diagnosis of carcinoma in SSA/P, cancer：well to poorly differentiated adenocarcinoma [solid type (Por1) medullary carcinoma], T1b (2,500μm), ly0, v0 was confirmed. Genetic screening of the lesion identified a BRAF mutation and CIMP in each region of the carcinoma and SSA/P. Methylation of hMLH1 was evident in the SSA/P and well-differentiated carcinoma regions, but was absent from poor to moderately differentiated carcinoma regions. We conclude that this lesion is microsatellite instability-positive colon carcinoma originating from the SSA/P. Additionally, we also conclude that the medullary carcinoma located within the depression must have arisen from a different source. |
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