| 連載名 | 第23回 大腸IIc研究会 優秀演題 | |
|---|---|---|
| 題名 | 超拡大内視鏡で観察したIIa＋IIc型SM深部浸潤癌の1例 | |
| 発刊年月 | 2014年 11月 | |
| 著者 | 漆原 史彦 | 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 | 森 悠一 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 一政 克朗 | 昭和大学横浜市北部病院消化器センター |
| 著者 | 石田 文生 | 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 |
| 【 要旨 】 | 48歳，男性．大腸内視鏡検査にて上行結腸に腫瘍径12mm大のやや発赤調の平坦な病変を認めた．インジゴカルミン散布像でIIa＋IIc型病変と診断した．陥凹内にはNBI拡大観察像でsparse patternを，クリスタルバイオレット染色下拡大観察像でⅤI高度不整pit patternおよびⅤN型pit patternを認めた．超拡大内視鏡（Endocytoscopy；EC）観察ではEC分類でのEC3bを認めたため，SM深部浸潤癌と診断し，腹腔鏡補助下結腸切除術を施行した．最終病理組織診断はadenocarcinoma（tub2>tub1），sm2，pSM，1,375μm，ly0，v0，budding：G2，pN0であった． 内視鏡所見と病理像を比較対照したところ，病理像で癒合管状傾向を示す癌腺管が表層に露出している部位に一致して不整な核腫大を伴うEC分類でのEC3bの所見が観察され，表層組織の推定にEndocytoscopyが有用と考えられる1例であった． |
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| Series | ||
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| Title | Case of type 0-IIa＋IIc early colorectal cancer diagnosed with Endocytoscopy | |
| Author | Fumihiko Urushibara | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Shin-ei Kudo | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Yuichi Mori | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Katsuro Ichimasa | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Fumio Ishida | Digestive Disease Center, Showa University Northern Yokohama Hospital |
| Author | Shigeharu Hamatani | Division of Pathology, Showa University Northern Yokohama Hospital |
| [ Summary ] | A 48-year-old man was referred to our center for a detailed examination of a depressed type lesion located in the ascending colon. White light endoscopy revealed a slightly reddish flat lesion 12 mm in diameter. Indigo carmine spraying revealed elevation and shallow depression of the lesion, with a clear border from the surrounding mucosa. As a results, a morphological type lesion was diagnosed as a type 0-IIa+IIc lesion. The vascular pattern was diagnosed as sparse using Narrow Band Imaging. Magnifying chromoendoscopy found type VN pit patterns in the depressed area. However, type VI pit patterns were most often observed. Endocytoscopy (EC; OLYMPUS), with ultra-magnification capability (380 or 450×) using a contact light microscopy system. We detected a destroyed gland and distorted nuclei in the depressed area. As a result, this lesion was diagnosed as EC3b using the EC classification. Based on the detailed endoscopic examination outlined above, this lesion was diagnosed as a massively invasive submucosal cancer. The patient underwent laparoscopic colectomy. The final pathological diagnosis was adenocarcinoma (tub2>tub1), with a submucosal invasion being positive, a depth of 1,375μm, lymphatic invasion negative, venous invasion was negative, budding was Grade 2 and nodal metastasis was negative. By comparing the pathological findings to endoscopic ones, EC findings of EC3b corresponded well with pathological findings of tubular adenocarcinoma exposed on the lesion surface. In this case, Endocytoscopy was useful in making an estimation of lesion pathology. |
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