INTESTINE Vol.21 No.2(13)


連載名 第25回 大腸IIc研究会 Young award
題名 腫瘍径10mmのIIc型SM浸潤癌の1例
発刊年月 2017年 03月
著者 渡部 真裕子 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 神山 勇太 昭和大学横浜市北部病院消化器センター
著者 工藤 豊樹 昭和大学横浜市北部病院消化器センター
著者 若村 邦彦 昭和大学横浜市北部病院消化器センター
著者 林 武雅 昭和大学横浜市北部病院消化器センター
【 要旨 】 症例は70歳,男性.回盲弁下唇に10mm大の発赤陥凹病変を認め,色素撒布によりIIc型と診断した.NBI拡大観察ではnetwork pattern,色素拡大観察ではIIIS型とVI型軽度不整pit patternを認めた.超拡大内視鏡ではEC3aと診断し,SM微小浸潤と予想した.一括切除目的にESDを施行し,病理診断はAdenocarcinoma (tub1),T1a (SM 100µm)であった.肉眼型IIc型の回盲弁早期癌という貴重な1例を経験したため報告する.
Series
Title 10 mm IIC type submucosal cancer on ileocecal valve
Author Mayuko Watanabe Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Shin-ei Kudo Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Yuta Koyama Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Toyoki Kudo Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Kunihiko Wakamura Digestive Disease Center, Showa University Northern Yokohama Hospital
Author Takemasa Hayashi Digestive Disease Center, Showa University Northern Yokohama Hospital
[ Summary ] A 70 year-old male underwent a total colonoscopy at our institute. A slightly red lesion of 10 mm in diameter was detected on the ileocecal valve. After dye spraying, a depression was clarified, presenting as a type IIC lesion. The depressed portion of the lesion showed a network pattern thorough narrow-band imaging. Magnifying endoscopy using crystal violet staining exhibited Kudo's IIIS pit patterns mainly throughout the depressed area. Type VI low grade pit patterns were found in the central area of the depression. In the central area where Kudo's VI low grade pit patterns were noted, endocytoscopic (EC) imaging revealed irregular lumen containing slightly swollen nuclei. It was diagnosed as EC3a in the EC classification. Therefore, the lesion was suspected as a slightly invasive submucosal tumor. In order to perform an enbloc resection, ESD was performed.
Pathological diagnosis revealed adenocarcinoma (tub1), T1a (SM 100 µm), ly0 (D2-40), v0 (VB), budding Grade 1, pHM0, pVM0.
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