INTESTINE Vol.16 No.6(2-1)


特集名 SSA/Pの本態を探る
題名 臨床診断の立場から (1) 病変の発見,通常観察を中心に
発刊年月 2012年 11月
著者 藤井 隆広 藤井隆広クリニック
著者 藤盛 孝博 獨協医科大学人体分子病理
【 要旨 】 HPを含む大腸鋸歯状病変2,261病変のうち,SSA/Pは199病変(8.8%)に認められた.TSAを除く10mm以上の鋸歯状病変245病変中,LHPは95病変(38.8%),SSA/Pは150病変(61.2%)であり,JSCCRの組織診断基準に基づけば両者は同一のものではないと考えられる.しかしながら,両者の通常内視鏡による鑑別診断は困難であり,肉眼形態上ⅠsまたはⅠs+IIaの形態がSSA/P>LHPとして認められる以外,明らかな違いは得られなかった.これら両者の存在診断においては,右半結腸の粘液を覆う病変に注目することが肝要であり,その一助としてNBI観察の有用性が示唆された.
Theme How should we interpret sessile serrated adenoma/polyp ?
Title Detection and diagnosis of SSA/P using standard colonoscopy
Author Takahiro Fujii Takahiro Fujii Clinic
Author Takahiro Fujimori Department of Pathology, Dokkyo Medical University
[ Summary ] Of the 2261 serrated lesions including hyperplastic polyps (HPs) examined, sessile serrated adenomas/polyp (SSA/Ps) were found in 199 lesions (8.8 %). In addition, of the 245 serrated lesions measuring 10 mm or greater examined, excluding traditional serrated adenomas (TSAs), large hyperplastic polyps (LHPs) and SSA/Ps were found in 95 (38.8 %) as well as 150 (61.2 %) lesions, respectively. This suggests that LHPs and SSA/Ps may constitute identical pathological entities based on the JSCCR criteria for histological diagnosis of serrated lesions. However, LHPs and SSA/Ps do not lend themselves to differential diagnosis with conventional colonoscopy. This suggests they do not differ greatly in macroscopic terms, while Is or Is + IIa are more frequently associated with SSA/Ps than with LHPs. It is therefore suggested that it is critically important to focus attention on lesions covering the mucus in the right colon. Narrow-band imaging (NBI)-based observation may be useful, in the detection and differentiation of these lesions.
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