| 特集名 | 『早期大腸癌』からの20年，『INTESTINE』からの今後20年 | |
|---|---|---|
| 題名 | 大腸鋸歯状病変─現状と将来展望 | |
| 発刊年月 | 2016年 01月 | |
| 著者 | 長田 修一郎 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 鶴田 修 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 河野 弘志 | 聖マリア病院消化器内科 |
| 著者 | 前山 泰彦 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 永田 務 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 向笠 道太 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 秋葉 純 | 久留米大学医学部病理学講座 |
| 著者 | 光山 慶一 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 著者 | 鳥村 拓司 | 久留米大学医学部内科学講座消化器内科部門／久留米大学医学部消化器病センター |
| 【 要旨 】 | 大腸鋸歯状病変は病理組織学的にはHP（hyperplastic polyp），SSA/P（sessile serrated adenoma/polyp），TSA（traditional serrated adenoma）の大きく3種に分類するのが一般的である．SSA/PはHPに類似するが構造異型や細胞異型を有する点でHPとは異なり，右側結腸のMSI 陽性大腸癌の前駆病変の一つである．SSA/Pの内視鏡診断には拡大内視鏡所見における開II型pitやNBI拡大観察におけるVMV（varicose microvascular vessel）などが有意な所見であるとされている．SSA/Pについて，内視鏡的治療を行うべき病変の基準については定説がなく，臨床的に重要な課題である．SSA/Pの一部に管状腺腫様構造やTSA様構造が発生することが知られており，WHO分類ではこれらをSSA/P with cytological dysplasiaと表現している．今後はこれらの鋸歯状病変を集積し，癌化率や癌併存病変の内視鏡所見，臨床病理学的特徴，分子生物学的特徴について検討を重ね，鋸歯状病変の本質を明らかにしていく必要がある． | |
| Theme | "Early Colorectal Cancer" and "Intestine", Road to future | |
|---|---|---|
| Title | Colorectal serrated polyps : Current knowledge and future prospects | |
| Author | Shuichiro Nagata | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Osamu Tsuruta | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Hiroshi Kawano | Unit of Gastroenterology, St. Mary's Hospital |
| Author | Yasuhiko Maeyama | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Tsutomu Nagata | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Michita Mukasa | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Jun Akiba | Division of Pathology, Kurume University School of Medicine |
| Author | Keiichi Mitsuyama | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| Author | Takuji Torimura | Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine / Department of Endoscopy, Kurume University School of Medicine |
| [ Summary ] | The histopathology of colonic serrated lesions is generally classified into three categories : hyperplastic polyp (HP), sessile serrated adenoma/polyp (SSA/P), and traditional serrated adenoma (TSA). SSA/P resembles HP, but is one of the outrider lesions of the microsatellite instability (MSI) positive colorectal cancers on the right side of the colon. Unlike HP, at a point having the structure variant and the cell variant. This is a significant finding for the endoscopic diagnosis of SSA/P, type II-open pit pattern and VMV in NBI magnified observation. Since there is no established theory about how the criteria of SSA/P should be used in endoscopic treatment, this has important clinical implications. It is known that tubular adenoma like structures and TSA like structures are generated from a part of the SSA/P ; these are expressed as SSA/P with cytological dysplasia in the WHO classification. In the future, we need to integrate these serrated lesions and study the malignant transformation rate, the endoscopic findings, the clinicopathological features, and the molecular biological features of the cancer coexisting lesions, and continue to clarify the essence of the colorectal serrated lesions. | |