INTESTINE Vol.21 No.1(5-2)


特集名 大腸Interval cancerをめぐる最近の知見
題名 大腸Interval cancerの症例報告(2)ポリープ切除3年後のサーベイランスで発見された直腸Interval cancerの1例
発刊年月 2017年 01月
著者 千葉 秀幸 大森赤十字病院消化器内科
著者 木庭 郁朗 山鹿中央病院消化器科
著者 立川 準 大森赤十字病院消化器内科
著者 栗原 大典 大森赤十字病院消化器内科
著者 芦苅 圭一 大森赤十字病院消化器内科
著者 高橋 昭裕 練馬光が丘病院消化器内科
著者 後藤 亨 大森赤十字病院消化器内科
【 要旨 】 症例は70歳代,男性.初回検査では異常は指摘されずその1年後他院で大腸内視鏡検査を施行し,腺腫を2カ所切除した.3年後の大腸内視鏡フォロー目的にて当院で大腸内視鏡検査を施行,直腸Raに30mm大のLST-NG-PD病変を認めた.NBI拡大・色素拡大内視鏡所見よりMからSM軽度浸潤癌と診断し内視鏡的切除の方針となった.病理診断は高分化腺癌,pSM(760µm),ly0,v0,断端陰性であった.本例が見逃し癌か急速発育癌かの判定は困難だが,直腸でのinterval cancerもまれではないこと,LST-NG病変にも留意するべきであると考えられた.
Theme Current topics in interval colorectal cancers
Title Case of rectal interval cancer detected with surveillance colonoscopy three years post initial colonoscopic polypectomy
Author Hideyuki Chiba Department of Gastroenterology, Omori Red Cross Hospital
Author Ikuro Koba Department of Gastroenterology, Yamaga Chuo Hospital
Author Jun Tachikawa Department of Gastroenterology, Omori Red Cross Hospital
Author Daisuke Kurihara Department of Gastroenterology, Omori Red Cross Hospital
Author Keiichi Ashikari Department of Gastroenterology, Omori Red Cross Hospital
Author Akihiro Takahashi Department of Gastroenterology, Nerima-Hikarigaoka Hospital
Author Toru Goto Department of Gastroenterology, Omori Red Cross Hospital
[ Summary ] A man in his seventies underwent colonoscopic polypectomy for two adenomatous lesions one year after an initial negative colonoscopy. However, surveillance colonoscopy three years after the previous colonoscopy indicated a laterally spreading tumornon granular depressed type 30 mm in size in the rectum above the peritoneal reflection. Because Narrow Band Imaging (NBI) with magnification and magnifying chromoendoscopy suggested M or SM slight invasion, endoscopic treatment was performed. Histological findings revealed a well-differentiated adenocarcinoma with slight invasion (760 µm) without lymphovascular invasion or budding. It is impossible to know whether a case is due to missed cancer from initial colonoscopy or a rapid growth lesion. This case is significant in terms of being a case report because interval cancer in the rectum is relatively common. Therefore, we must pay attention to LST-NG as exhibiting a high potential for interval cancer.
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