特集名 | colitic cancer診断update | |
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題名 | 2. 診断 (2) 拡大内視鏡診断 b. colitic cancer,およびdysplasiaの内視鏡所見 -- NBI,AFI症例も含め拡大観察を中心に | |
発刊年月 | 2009年 05月 | |
著者 | 渡邊 真 | 藤田保健衛生大学消化管内科 |
著者 | 丸山 尚子 | 藤田保健衛生大学消化管内科 |
著者 | 神谷 芳雄 | 藤田保健衛生大学消化管内科 |
著者 | 藤田 浩史 | 藤田保健衛生大学消化管内科 |
著者 | 中川 義仁 | 藤田保健衛生大学消化管内科 |
著者 | 長坂 光夫 | 藤田保健衛生大学消化管内科 |
著者 | 岩田 正己 | 藤田保健衛生大学消化管内科 |
著者 | 高濱 和也 | 藤田保健衛生大学消化管内科 |
著者 | 平田 一郎 | 藤田保健衛生大学消化管内科 |
【 要旨 】 | 当科で拡大内視鏡観察を施行したcolitic cancer(CC)9例(進行癌4例4病変,早期癌5例8病変)12病変,dysplasia 6例7病変の計19病変を対象とし,通常観察,拡大観察(クリスタルバイオレット染色,NBI観察)について検討した.肉眼形態は,扁平隆起7病変,顆粒結節集簇型7病変,有茎性隆起2病変,広基性隆起1病変,平坦2病変に分類された.病変の色調は,全体の12病変(63%)で発赤,7病変(37%)で褪色あり,CCでは66%が発赤であった.pit patternはCCの癌部では,VI型6病変(50%),IV型4病変(33%)が多く,VN型は1病変(8%)と少なかった.CC周辺のdysplasia部では,絨毛構造を含むIV型が57%と多く,IIIL型が43%であった.dysplasia 7病変では,IV型pitが6例(86%)と主体であった.NBI観察を行ったCC 5病変(SS 1病変,SM 2病変,M 2病変)では,佐野らの分類のIIIA型であり,dysplasia 3病変はII型であった.上記のように,CCとdysplasiaでは,病変の発赤調とIV型pitの頻度が高く,寛解期にはNBI観察も有用であった. |
Theme | Update in management of colitic cancer | |
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Title | Magnifying endoscopy for diagnosis of colorectal cancer and dysplasia -- associated with ulcerative colitis | |
Author | Makoto Watanabe | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Naoko Maruyama | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Yoshio Kamiya | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Hiroshi Fujita | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Yoshihito Nakagawa | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Mitsuo Nagasaka | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Masami Iwata | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Kazuya Takahama | Department of Gastroenterology, Fujita-Health University School of Medicine |
Author | Ichiro Hirata | Department of Gastroenterology, Fujita-Health University School of Medicine |
[ Summary ] | Magnifying endoscopy has been used in the diagnosis of dysplasia and colitic cancer (CC) as well as sporadic neoplasia. We investigated the magnified endoscopic features of ulcerative colitis associated dysplasia and colitic cancer. Nineteen lesions associated with dysplasia and CC were included in this study. Magnified findings were classified by using Kudo's pit pattern criteria. Morphologically these lesions were classified into flat elevated, granular aggregated, sessile, protruded and flat types. Six lesions of flat elevated type and granular aggregated type were seen out of nineteen total lesions. The mucosal color of lesions was reddish in 63%. In magnifying endoscopic examination, type VI pit patterns was observed in 50% of CC cases and type IV pit patterns were identified in 33% of CC cases. Type IV pit patterns were seen in 85% of dysplasia cases. Type IV pit patterns were divided into villous patterns and branched patterns. NBI observation commonly showed type IIIA MC patterns with CC lesion and type II MC pattern with dysplasia. Type IV pit patterns were thought to be typical with both CC and dysplasia. Further studies are necessary to develope endoscopic diagnosis of CC and dysplasia. |