INTESTINE Vol.20 No.1(12)

特集名 『早期大腸癌』からの20年,『INTESTINE』からの今後20年
題名 大腸癌の病理診断の歴史と将来─とくに早期大腸癌について
発刊年月 2016年 01月
著者 太田 敦子 福岡大学筑紫病院病理部
著者 岩下 明德 福岡大学筑紫病院病理部
著者 池田 圭祐 福岡大学筑紫病院病理部
著者 田辺 寛 福岡大学筑紫病院病理部
【 要旨 】 わが国の大腸癌の病理診断は,大腸内視鏡検査による生検診断,ポリペクトミーや内視鏡的粘膜切除術(EMR)などによるポリープ切除標本の診断,近年は内視鏡的粘膜下層剝離術(ESD)による早期大腸癌の診断など,臨床の先生方の診断学,治療学の急速な発展に牽引されるようなかたちでともに進んできた.
大腸癌の発生について,adenoma-carcinoma sequence説と“de novo”carcinoma説が以前より議論となっていた.adenoma-carcinoma sequence説が優勢となっていた当時に平坦・陥凹型早期大腸癌の発見でde novo癌の存在が注目され,その議論に一石を投じた.現在ではどちらの発癌経路も存在することが共通の認識となっている.
Theme "Early Colorectal Cancer" and "Intestine", Road to future
Title Diagnostic pathology of colorectal carcinoma in Japan : a historical perspective and recent advances
Author Atsuko Ota Department of Pathology, Fukuoka University Chikushi Hospital
Author Akinori Iwashita Department of Pathology, Fukuoka University Chikushi Hospital
Author Keisuke Ikeda Department of Pathology, Fukuoka University Chikushi Hospital
Author Hiroshi Tanabe Department of Pathology, Fukuoka University Chikushi Hospital
[ Summary ] In Japan, the first step of pathological diagnoses of colorectal carcinoma involves diagnosing the surgically resected specimens. Following this, other diagnostic methods, such as those involving biopsies by colonoscopy as well as specimens obtained by endoscopic resection, polypectomy, or endoscopic mucosal resection (EMR), are used. along with the recent inclusion of other approaches such as diagnoses of early colorectal cancer by endoscopic submucosal dissection (ESD). The rapid development of diagnostics and therapeutics of clinical importance have led to advances in pathological diagnoses. Two different theories regarding the development of colorectal cancer have been under a long-standing debate. When the adenoma-carcinoma sequence theory was dominant, the discovery of a flat or depressed early colorectal cancer laid attention to the existence of "de novo" cancers. The current common understanding is that both oncogenic pathways exist. We also outlined the differences in the diagnostic criteria for diagnoses of colorectal epithelial neoplasms among pathologists, rationale for such differences, differences in the diagnostic criteria between Japanese and Western pathologists, and establishing a consensus classification (Vienna classification) on the basis of such differences.