Mitooka H
Center for Digestive Diseases, Kobe Kaisei Hospital, Japan.
Semin Gastrointest Dis. 2000 Oct;11(4):238-47.
Flat adenomas have a higher risk of association with adenocarcinoma than the protruded type, and flat cancer has a tendency to invade deeply despite its small size. Furthermore, it has been suggested that flat, small carcinomas readily invade through the muscularis mucosa into the submucosa and are associated with an increased risk of early metastasis into lymph nodes, as compared with polypoid growth pattern cancers. It has become evident that these lesions are becoming more common in Japan, as well as in some western countries. It has been generally believed that the colon is comparable to the stomach in terms of endoscopic diagnostic capability and accuracy. Therefore, we were surprised to learn that flat neoplasms, including flat or depressed adenomas and cancers, exist in the colon, as they seem to have previously been overlooked. Recent significant advances in endoscopic resolution and the development of improved diagnostic techniques and modalities may play an important role in the detection of such lesions. In the present study, the diagnosis and management of such lesions, along with their genetic background, is reviewed. Some techniques for their detection currently being used in Japan will also be reviewed using several actual cases.
扁平腺瘤比隆起型腺瘤与腺癌相关的风险更高，扁平癌尽管体积小但有深层浸润的倾向。此外，有人提出，与息肉样生长模式的癌症相比，扁平小癌更容易穿过黏膜肌层侵入黏膜下层，并与早期淋巴结转移风险增加相关。显然，这些病变在日本以及一些西方国家正变得越来越常见。人们普遍认为，在结肠镜诊断能力和准确性方面，结肠与胃相当。因此，当我们得知结肠中存在扁平肿瘤，包括扁平或凹陷型腺瘤和癌症时感到很惊讶，因为它们似乎此前一直被忽视。内镜分辨率的近期重大进展以及改进的诊断技术和方式的发展可能在这类病变的检测中发挥重要作用。在本研究中，将对这类病变的诊断、管理及其遗传背景进行综述。还将通过几个实际病例对目前日本正在使用的一些检测技术进行综述。
