| 特集名 | 内視鏡で遭遇する大腸隆起型および表面型病変を見直す | |
|---|---|---|
| 題名 | 粘膜下腫瘍（SMT） (3) その他のSMT（脂肪腫・リンパ管腫など） | |
| 発刊年月 | 2011年 11月 | |
| 著者 | 平田 一郎 | 藤田保健衛生大学消化管内科 |
| 【 要旨 】 | 大腸粘膜下腫瘍（SMT）のうち消化管間葉系腫瘍（GIMT）に包括されるものには，良性腫瘍としては脂肪腫，平滑筋腫，血管腫，リンパ管腫，神経Á腫，神経線維腫，顆粒細胞腫などがあげられ，発生頻度は脂肪腫と平滑筋腫で大半を占めている．一方，悪性腫瘍としては平滑筋肉腫，血管肉腫，悪性黒色腫，GIST，Kaposi肉腫などがあげられ，そのなかで平滑筋肉腫が大半を占めている． SMTの肉眼形態は，なだらかな立ち上がりを呈する限局性の粘膜隆起で，病変と周囲粘膜との境界は不明瞭であり，時に架橋ひだ（bridging fold）を認める．病変の色調は，一般的に脂肪腫は黄色調，リンパ管腫では透明感のある白色調，血管腫は赤色・青色調を呈する．脂肪腫やリンパ管腫は非常に軟らかく，鉗子で押すと容易にへこむ（cushion sign）． 大腸SMTに対する治療法としては，症状の有無や病変の性状に応じて経過観察，内視鏡治療または外科的治療（腹腔鏡下手術，開腹手術）などが選択される． |
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| Theme | Reappraisal of Colorectal Protruded and Flat Lesions Which are Encountered During Endoscopy | |
|---|---|---|
| Title | Review of Diagnosis and Treatment of Colonic Submucosal Tumors, Especially GIMT | |
| Author | Ichiro Hirata | Department of Gastroenterology, Fujita Health University |
| [ Summary ] | Types of colonic SMT (submucosal tumor) include benign GIMT (gastrointestinal mesenchymal tumor), including lipoma, leiomyoma, hemangioma, lymphangioma, schwannoma, neurofibroma, and granular cell tumor. Lipomas and leiomyomas are for the most commonly observed lesions. On the other hand, leiomyosarcomas, angiosarcomas, malignant melanomas, GIST(gastrointestinal stromal tumor) and Kaposi sarcoma are associated with malignant GIMT. Leiomyosarcoma accounts for the most commonly associated condition. The macroscopic characteristic of the SMT are gentlysloping protubaerances with non-differentiated borders between the base of the lesion and the circumference of the mucosa, sometimes exhibiting bridging folds. Lipomas display yellowish colors and lymphangiomas are white and somewhat transparent. Hemangiomas commonly present with red to blueish colors. Lipomas and lymphangiomas are very soft and become dented easily when the lesion is pushed with a forceps (cushion sign). Concerning therapy for colonic SMT follow-up, endoscopic treatment or surgical treatment is chosen depending on the presence or absence of symptoms and the property of the lesion concerned. |
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