| 連載名 | 第24回大腸Ⅱc研究会 優秀演題 | |
|---|---|---|
| 題名 | 粘膜下腫瘍様の隆起を呈した10mmのS状結腸病変の1例 | |
| 発刊年月 | 2016年 03月 | |
| 著者 | 宍戸 華子 | 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 英行 | 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 | 御子神 哲也 | 昭和大学横浜市北部病院病理診断科 |
| 【 要旨 】 | 症例は40歳代，女性．下部消化管内視鏡検査でS状結腸に約10mmの粘膜下腫瘍様の病変を認めた．インジゴカルミン散布では頂部に陥凹を認めたが周囲は正常粘膜で被覆されていた．粘膜下腫瘍様の形態を呈しており，肉眼形態はいわゆる広義の0-Ⅰs＋IIcと診断した．NBI拡大観察では陥凹部はirregular 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部でⅤI型高度不整pit patternを認めた．超拡大内視鏡観察では，腺腔は不整形で核は濃染しやや腫大しており，EC3aと診断した． 以上より，本症例は粘膜下層深部以深の浸潤癌と診断した．さらに上述の病変の約16cm肛門側のS状結腸に13mm大の0-IIa＋IIc病変を認め，粘膜下層深部浸潤癌と診断した．各々は独立した病変と考え，2病変併せて腹腔鏡補助下S状結腸切除術を施行した． 病理所見は，10×10mm，Type 0-Ⅰs＋IIc，adenocarcinoma(tub1＞tub2)，pT3(v)-MP，med，INFa，ly0，v1(VB)，pN3(9/27)，肛門側の病変は13×10mm，Type 0-IIa＋IIc，adenocarcinoma(tub2)，pT1b，sm3(SM 6,000μm)，med，INFa，ly0，v1(VB)であった． 粘膜下腫瘍様の形態を呈する大腸癌において詳細な拡大内視鏡所見と病理所見の対比が可能であった症例はきわめてまれであり，報告をする． |
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| Title | Case of 10 mm sized submucosal tumor-like lesion in sigmoid colon | |
| Author | Hanako Shishido | 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 | Tetsuya Mikogami | Division of Pathology, Showa University Northern Yokohama Hospital, |
| [ Summary ] | A female in her 40's was indicated for close examination. A 10 mm sized lesion resembling a submucosal tumor was observed in sigmoid colon. With dye spraying, a depressed lesion could be observed on the top of the lesion. However, it was primarily surrounded by normal mucosa. In a broad sense, it could be diagnosed as 0-Is +IIc. The depressed portion of the lesion exhibited an irregular pattern through narrow-band imaging. With magnifying endoscopy after crystal violet staining, it exhibited a depressed portion with a VI high-grade pit pattern. Using endocytoscopy (EC) after methylene blue in addition to crystal violet staining, the depressed portion revealed EC3a in EC classification. EC3a is a classification defined as images of irregular and rough lumens and a large number of roundish nuclei when strongly stained. The lesion was diagnosed as advanced cancer. In addition, in the anal side of the sigmoid colon, there was another lesion which was diagnosed as invasive cancer. The two lesions were subjected to laparoscopic-assisted surgery at the same time. Histological examination revealed a 10×10 mm type 0-Is+IIc, adenocarcinoma(tub1>tub2), pT3(v)-MP, med, INFa, ly0, v1(VB), pN3(9/27). Histological examination of the anal side lesion revealed a 13×10 mm, type 0-IIa+IIc, adenocarcinoma(tub2), pT1b, sm3(SM 6,000μm), med, INFa, ly0, v1(VB). Submucosal tumor like colorectal carcinomas are very rare. In such cases, it is very important to observe in detail by using magnifying endoscopy in relation to histological findings. |
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