大腸微小腺腫における陥凹の消失 : 3名の家族性大腸腺腫症患者の微小病変52ヶの組織学的検索を中心に Disappearance of Depression in Minute Lesions of Colonic Adenoma

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3名の家族性大腸腺腫症患者の予防的全大腸切除材料の肉眼検索で中央陥凹を有する病変を全例に認めた.このような病変を含む粘膜領域4カ所を選び,長径2mm以上の全病変を切出して組織学的に検索した,表面型ないし無茎型の腺腫病変52ヶの平均長径は2.5mmで,その中央の粘膜固有層(以下,固有層と略す)の厚みを非病変部と比較した値(厚み値)が負のものではリンパ濾胞を伴うことが多く(20ヶ中15ヶ,p<0.05),筋板の断裂も見られた.正のものでは腫瘍腺管が筋板と離れていることが多かった(23ヶ中16ヶ,p<0.05).厚み値の度数分布は単峰性で,52ヶを「陥凹群」と「隆起群」に区別することはできなかった.炎症に伴って筋板や固有層間質が変化することにより,微小腺腫病変中央の陥凹が消失する可能性が示唆された.

Gross examination of 3 total colectomy specimens resected for familial adenomatous polyposis enabled recognition of sessile lesions with central depression in all of them. Four mucosal regions containing those lesions were selected and all lesions no less than 2 mm in diameter were examined histologically. In 52 sessile adenomatous lesions, the thickness of lamina propria in the center was compared to that in normal mucosa, and the thickness value (TV) was obtained. In thinner lesions (lesions with negativa TV), lymphoid follicles, which sometimes disrupted muscularis mucosae, were more frequently observed (in 15 of 20 lesions, p<0.05). In lesions with positive TV, adenomatous glands were more frequently elevated away from muscularis mucosae (in 16 of 23 lesions, p<0.05), and interposition of non-adenomatous glands between them were observed. In the 52 lesions, TV distribution seemed to be normal. It was suggested that they should not be divided into thinner and thicker subgroups, but that the central depression may disappear accompanied with alteration of stroma and muscularis mucosa by inflammation.

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  • 日本大腸肛門病学会雑誌

    日本大腸肛門病学会雑誌 50(3), 155-162, 1997-03-01

    The Japan Society of Coloproctology

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