| 連載名 | 第23回大腸IIc研究会 優秀演題 | |
|---|---|---|
| 題名 | IIa＋IIc型を呈した直腸Rb SM深部浸潤癌の1例 | |
| 発刊年月 | 2014年 09月 | |
| 著者 | 趙 智成 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 三澤 将史 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 工藤 進英 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 宮地 英之 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 石田 文夫 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 濱谷 茂治 | 昭和大学横浜市北部病院病理診断科（当時） |
| 【 要旨 】 | 症例は70歳代，男性．下部消化管内視鏡検査（CS）で直腸Rbに13mmの軽度発赤調で周囲に白斑を伴う平坦な病変を認め，インジゴカルミン散布で段差を有する陥凹局面が明瞭となり陥凹局面は周囲正常粘膜と比較してやや高く，肉眼形態をIIa＋IIcと診断した．NBI拡大観察では陥凹局面はsparse patternを呈していた．クリスタルバイオレット染色後の拡大観察では陥凹局面はVI型高度不整pit patternとVN型pit patternを認めた．無構造領域を呈した部分の超拡大内視鏡観察では腺腔は完全に破壊されておりEC3bと診断し，さらにdesmoplastic reaction（DR）の露出を疑う所見も認めた． 以上より，SM深部浸潤癌と診断し外科的切除の適応と判断したが，拒否されたため十分な説明のうえEMR を施行した．病理所見はadenocarcinoma（tub2），sm2，pSM1,625μm，ly0（D2-40），v0（VB），budding Grade2，pHM0，pVM0であった． 拡大内視鏡所見および超拡大内視鏡所見が病理組織学的所見と対応可能であったIIa＋IIc型SM深部浸潤癌を経験したので報告する． |
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| Series | ||
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| Title | Case of massively invasive submucosal colorectal cancer : type IIa + IIc | |
| Author | Tomonari Cho | Department of Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Masashi Misawa | Department of Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Shin-ei Kudo | Department of Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Hideyuki Miyachi | Department of Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Fumio Ishida | Department of Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Shigeharu Hamatani | Division of Pathology, Showa University Northern Yokohama Hospital |
| [ Summary ] | A 70 year-old man underwent a total colonoscopy. The colonoscopy revealed a type IIa + IIc lesion in the lower rectum. The depressed portion of the lesion showed a sparse pattern through narrow-band imaging. Magnifying endoscopy using crystal violet staining, the exhibited a depressed portion with both Kudo's VN pit patterns and VI pit patterns. Employing endocytoscopy (EC) using methylene blue in addition to crystal violet, the depressed porion which showed Kudo's VN pit patterns magnifying endoscopy revealed EC3b in the EC classification. EC3b is a classification defined as images of unclear gland formation and agglomeration of distorted nuclei. In the present case, we also detected fine granular cells in the EC3b area, which might reflect exposure due to desmoplastic reaction (DR). The lesion was diagnosed as massively invasive submucosal cancer. We removed the lesion with endoscopic mucosal resection because the patient rejected a surgical procedure. Pathological diagnosis of the rectal specimen revealed adenocarcinoma (tub2), sm2, pSM1,625μm, ly0 (D2-40), v0 (VB), budding Grade2, pHM0, pVM0. EC imaging may be useful for in vivo histopathological prediction of submucosal cancer. |
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