表面型大腸腫瘍にみられる"偽足様所見"の診断学的, 腫瘍生物学的検討  [in Japanese] DIAGNOSTIC SIGNIFICANCE OF "PSEUDOPODIA-LIKE APPEARANCE" IN SUPERFICIAL TUMORS OF THE COLON  [in Japanese]

Access this Article

Search this Article

Author(s)

    • 尾田 恭 ODA Yasushi
    • 国立がんセンター東病院内視鏡部 Endoscopy Division, National Cancer Center Hospital East

Abstract

偽足様所見を側方発育型腫瘍(LST)非顆粒型の診断指標としてとらえ,本所見を有する表面型腫瘍を,臨床病理学的,遺伝子的見地から,他の表面型腫瘍あるいは顆粒型LSTと比較した.10mm以上では,非顆粒型はsm浸潤は7%で,sm浸潤例は20mm以上であった.肉眼形態は,非顆粒型は総じて平坦隆起であったが,20mmを越えると平坦隆起の一部に相対陥凹を認める割合が増加した.遺伝子的には,K-rasの点突然変異は認めず,p53は腫瘍内の異型度にかかわらずびまん性に過剰発現した.10mm未満でも,偽足様所見をもつ表面型腫瘍は,10mm以上の場合と同様の遺伝子的結果を示し,10mm未満でよくみられる形態類似のIIaとの違いを認めた.従って偽足様所見をもつ表面型腫瘍はIIa+IIc,IIcと同じ遺伝子的背景でありながら,腫瘍径が大きくなるまで浸潤しない特殊な腫瘍群として,すなわち非顆粒型LSTとして扱うことが妥当であると考えられた.

The word of "laterally spreading tumor (LST)" proposed by Kudo is getting familiar, but the concept of non-granular type among LST has not reached an established theory compared with granular type among LST. The problems especially in the differences with ha or nodular-aggregating tumor, regulations of sizes and handling when it shows partial depression still remain to be solved. The author proposed "Pseudopodia-like appearance" of the superficial tumor as the marker of the potential to grow to lateral side ; such tumor is supposed to be equivalent to non-granular type. "Pseudopodia-like appearance" is a general term indicating the edge shape of the tumor which protrudes outside like amoebase's pseudopodia. To examine the significance of "Pseudopodia-like appearance", they were compared with other superficial tumors (ha, IIa+IIc and IIc) and granular type among LST in the aspects of clinicopathological and genetic findings. The characteristics of non-granular type were as follows ; In those more than 10mm in size, non-granular type showed 11% of sm involvement, which were all more than 25mm, and they all showed polypoid growth histologically by Shimoda and Ikgami's classification. In the gross shape, most of them showed flat elevation. The rate including partial slight depression increased in the tumors more than 20mm in size, which did not correspond to sm involvement. On the other hand, the tumor with absolute depression which was shown in only 1 case was sm involvement. In genetic findings, there were no K-ras point mutations in non-granular type and overexpressions of p53 were diffusely observed all over the tumor in spite of diversity of histological atypism. Even in those less than 10mm in size, superficial tumor with "Pseudopodia" also showed the same characteristics as those more than 10mm i size and moreover showed the differences from ha which showed the same shape of flat elevation and were commonly seen in those less than l0mm in size. Therefore, it was suggested that superficial tumors with "Pseudopodia" should be dealt with as the specific tumor which has the same genetic backgrounds with ha + IIc or IIc and nevertheless does not invade until it grows in a larger size. That is equivalent to the concept of non-granular type of laterally spreading tumor.

Journal

  • GASTROENTEROLOGICAL ENDOSCOPY

    GASTROENTEROLOGICAL ENDOSCOPY 38(12), 2815-2825, 1996-12-20

    Japan Gastroenterological Endoscopy Society

References:  14

Cited by:  6

Codes

  • NII Article ID (NAID)
    10008709020
  • NII NACSIS-CAT ID (NCID)
    AN00192102
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03871207
  • Data Source
    CJP  CJPref  J-STAGE 
Page Top