Clinical Endoscopy

  • 제40권5호
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  • Pages.303-308
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  • 2010
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  • 2234-2400(pISSN)
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  • 2234-2443(eISSN)
대한소화기내시경학회 (The Korean Society of Gastrointestinal Endoscopy)
권호 표지

대장직장 측방 발육형 종양의 아형에 따른 특징

Characteristics of Laterally Spreading Colorectal Tumors according to Morphologic Classifications

  • 박수범 (부산대학교 의학전문대학원 내과학교실) ;
  • 송근암 (부산대학교 의학전문대학원 내과학교실) ;
  • 이봉은 (부산대학교 의학전문대학원 내과학교실) ;
  • 류동엽 (부산대학교 의학전문대학원 내과학교실) ;
  • 김동욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 김태오 (부산대학교 의학전문대학원 내과학교실) ;
  • 김광하 (부산대학교 의학전문대학원 내과학교실)
  • Park, Su-Bum (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Song, Geun-Am (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Lee, Bong-Eun (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Ryu, Dong-Yup (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Kim, Dong-Uk (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Kim, Tae-Oh (Department of Internal Medicine, Busan National University School of Medicine) ;
  • Kim, Gwang-Ha (Department of Internal Medicine, Busan National University School of Medicine)
  • 투고 : 2009.09.29
  • 심사 : 2010.04.07
  • 발행 : 2010.05.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 장관벽을 따라 측방으로 자라는 측방 발육형 종양은 높이가 낮으며 색조의 차이가 거의 없거나 약간 붉게만 보여 대장내시경검사에서 놓치기 쉽다. 측방 발육형 종양을 육안 형태에 따라 분류하고 아형에 따른 호발부위와 악성률을 비교 분석하여 아형에 따른 진단과 치료에 도움이 되고자 하였다. 대상 및 방법: 2006년 3월 1일부터 2008년 8월 31일까지 부산대학교병원 소화기병센터에서 측방 발육형 종양으로 진단받고 내시경 절제 후 조직을 분석한 151명의 환자의 의무기록을 후향적으로 분석하였다. 측방 발육형 종양을 과립형과 비과립형으로 구분하였고, 과립형은 과립균일형과 결절혼합형으로, 비과립형은 평탄융기형과 위함몰형으로 세분하여 총 4군으로 아분류하였다. 내시경 치료를 통해 적출된 조직을 병리적으로 진단하여 선종의 종류, 악성화 여부 등을 판단하였다. 결과: 총 151명에서 측방 발육형 종양이 진단되었고 대상의 평균연령은 62.7세였으며, 남자가 83명(55%)이었다. 과립형이 87예(57.6%)로 더 많았다. 가장 흔한 호발부위는 상행결장이었으며 구불 결장 및 직장이 다음으로 흔하였다. 맹장에서는 과립형이, 횡행결장에서는 비과립형이 더 호발하였다. 전체 악성률은 21.2%이었고 크기가 클수록 악성률이 높았다. 아형별 악성률은 결절혼합형(25.9%)과 위함몰형(41.2%)이 과립균일형(3.0%)과 평탄융기형(10.0%)보다 높았다. 결론: 측방 발육형 종양은 형태에 따라 다른 임상병리적 특징을 가지며 크기가 커짐에 따라 악성률은 높아지므로 치료에 있어 형태 분류 및 크기가 중요한 고려사항이 된다. 따라서 치료에 있어서 형태에 따른 호발 부위를 인지하고 과립균일형은 큰 병변이라도 악성의 가능성이 적으므로 분할 절제도 가능할 것으로 생각되나, 결절혼합형과 위함몰형은 악성률이 높은 형태이므로 내시경 치료시 일괄 절제를 하도록 해야 할 것이다.

Background/Aims: Laterally spreading tumors (LSTs) are similar in color to the adjacent mucosa, so they are difficult to recognize. This study aimed to investigate the features of LSTs by morphologic classification and find effective diagnoses and treatments. Methods: This retrospective study was done between March 2006 and August 2008. We reviewed patients' medical records, endoscopic findings, and histological findings. Results: A total of 151 patients met criteria for LSTs. Eighty-seven lesions (57.6%) were of the granular type. The most frequent location was ascending colon (37.1%), followed by rectum and sigmoid colon (36.4%). The cecum is a common site in the granular type, but the transverse colon is common in the nongranular type. The overall malignancy rate was 21.2%, and the malignant rate increased in proportion to size. Malignant rates were higher for the mixed nodular type (25.9%) and pseudo-depressed type (41.2%) than for the homogeneous granular type (3.0%) or flat elevated type (10.0%). Conclusions: LSTs showed different clinicopathologic characteristics according to their morphologic classification. The homogenous type has a lower malignant potential. Piecemeal resection for those with a large diameter is possible, while the pseudo-depressed and mixed nodular types have a higher malignant potential and should receive en-bloc resection as soon as possible.

키워드

참고문헌

  1. Kudo S. Endoscopic mucosal resection of flat and depressed types of early colorectal cancer. Endoscopy 1993;25:455-461. https://doi.org/10.1055/s-2007-1010367
  2. Muto T, Kamiya J, Sawada T, et al. Small "flat adenoma" of the large bowel with special reference to its clinicopathologic features. Dis Colon Rectum 1985;28:847-851. https://doi.org/10.1007/BF02555490
  3. Tada S, Yao T, Iida M, Koga H, Hizawa K, Fujishima M. A clinicopathologic study of small flat colorectal carcinoma. Cancer 1994;74:2430-2435. https://doi.org/10.1002/1097-0142(19941101)74:9<2430::AID-CNCR2820740907>3.0.CO;2-C
  4. Matsumoto T, Iida M, Yao T, Fujishima M. Role of nonpolypoid neoplastic lesions in the pathogenesis of colorectal cancer. Dis Colon Rectum 1994;37:450-455. https://doi.org/10.1007/BF02076190
  5. Kuramoto S, Oohara T. Minute cancers arising de novo in the human large intestine. Cancer 1988;61:829-834. https://doi.org/10.1002/1097-0142(19880215)61:4<829::AID-CNCR2820610431>3.0.CO;2-P
  6. Ryu KH, Jang JY, Cha SW, et al. Clinicopathologic characteristics of laterally spreading tumors in colorectum. Korean J Gastrointest Endosc 2002;25:82-88.
  7. Lee YS, Kim SM, Yang HW, et al. Clinicopathological study on laterally spreading tumor (LST). Korean J Gastrointest Endosc 2002;24:206-211.
  8. Kudo S, Kashida H, Tamura S, Nakajima T. The problem of "flat" colonic adenoma. Gastrointest Endosc Clin N Am 1997;7:87-98.
  9. Okamoto T, Tanaka S, Haruma K, et al. Clinicopathologic evaluation on colorectal laterally spreading tumor (LST). Nippon Shokakibyo Gakkai Zasshi 1996;93:83-89.
  10. Rubesin SE, Saul SH, Laufer I, Levine MS. Carpet lesions of the colon. Radiographics 1985;5:537-552.
  11. Hurlstone DP, Korulla C, Lobo AJ. Colorectal laterally spreading tumors: clinical evaluation and endoscopic strategies updated. J Gastroenterol Hepatol 2002;17:1344-1345. https://doi.org/10.1046/j.1440-1746.2002.02912.x
  12. Kim HS, Lee KR, Park SY, et al. Characteristics and management of laterally spreading tumors. Korean J Gastrointest Endosc 1997;17:615-623.
  13. Kaneco K, Kurahashi T, Makino R, Konishi K, Mitamura K. Growth patterns of superficially elevated neoplasia in the large intestine. Gastrointest Endosc 2000;51:443-450. https://doi.org/10.1016/S0016-5107(00)70446-9
  14. Longacre TA, Fenoglio-Preiser CM. Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia. Am J Surg Pathol 1990;14:524-537. https://doi.org/10.1097/00000478-199006000-00003
  15. Kudo S, Kashida H, Tamura T. Early colorectal cancer: flat or depressed type. J Gastroenterol Hepatol 2000;15(suppl): 66S-70S.
  16. Kurisu Y, Shimoda T, Ochiai A, Nakanishi Y, Hirata I, Katsu KI. Histologic and immunohistochemical analysis of early submucosal invasive carcinoma of the colon and rectum. Pathol Int 1999;49:608-616. https://doi.org/10.1046/j.1440-1827.1999.00928.x
  17. Kudo S, Lambert R, Allen JI, et al. Nonpolypoid neoplastic lesions of the colorectal mucosa. Gastrointest Endosc 2008;68(suppl):3S-47S.
  18. Shimoda Y, Ikegami M, Fujisaki J, Matsui T, Aizawa S, Ishikawa E. Early colorectal carcinoma with special reference to its development de novo. Cancer 1989;64:1138-1146. https://doi.org/10.1002/1097-0142(19890901)64:5<1138::AID-CNCR2820640529>3.0.CO;2-A
  19. Tanaka S, Haruma K, Oka S, et al. Clinicopathologic features and endoscopic treatment of superficially spreading colorectal neoplasms larger than 20 mm. Gastrointest Endosc 2001;54:62-66. https://doi.org/10.1067/mge.2001.115729
  20. Jin H, Wu K, Ye H, Zhu Y, Zhang J, Ding Y. Size over 20 mm is an independent risk factor of endoscopic mucosa resection (EMR) for colorectal lateral spread tumor (LST): a prospective study and multivariate analysis. Cancer Therapy 2009;7:27-30.