INTESTINE Vol.4 No.3(3-2)


特集名 小さな(大きさ10mm以下)ポリープの取扱い --処置すべきか，フォローアップか
題名 小さなポリープの摘除にまつわる問題点 (2) 病理診断における諸問題
発刊年月 2000年 05月
著者 大倉 康男 埼玉県立がんセンター臨床病理部
【 要旨 】 要旨はありません。
Theme Strategy of managing small colorectal polyps
Title Histopathological problems in diagnosing the small colorectal polyps resected endoscopically
Author Yasuo Okura Department of Pathology, Saitama Cancer Center
[ Summary ] The effect of heat on endoscopic resection is the most important problem in histopthological diagosis. The degree of heat induced degeneration in the small colorectal polyps resected through hot biopsy, polypectomy or endoscopic mucosal resection(EMR) was examined. The results were as follows:
1. In the polyps less than 5mm in size, the frequency without heat induced degeneration was 79% in hot biopsy, 51% in polypectomy and 49% in EMR. Also in polyps from 6mm to 10mm in size, the rate was 83% in hot biopsy, 41% in polypectomy and 63% in EMR.
2. Marked heat induced degeneration through EMR was found in 20% of polyps less than 5mm in size. This is a very high rate in contrast to other resection procedures.
3. In the 73 polyps which could not be diagnosed at the cut-end, 40% were caused by heat induced changes, 37% from mistakes in cutting and 23% from both.
4. In the contrast to the differences between diagnosed biposy specimens and resected specimens, the diagnosis of most cases did not so change.
5. From the cases observed in long-term, none were was found that had developed the submucosal invasive cancer. And the histopathological diagosis had not so changed in the same polyps.
From this data, hot biopsy is seen to be a useful procedure in resecting the small polyps less than 5mm in size. And it is necessary to take care of the effect of heat in removal of small polyps through EMR. Therefore, in cases of the small polyps resected endoscopically, long-term observation through biopsy will be a useful method in the treatment of increasing numbers of small polyps.
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