Tamura Satoru, Furuya Yasuo, Tadokoro Takehisa, Higashidani Yoshifumi, Yokoyama Yuichi, Araki Keijiro, Onishi Saburo
First Department of Internal Medicine, Kochi Medical School, Kohasu, Okoh-cho, Nankoku 783-8505, Japan.
J Gastroenterol. 2002;37(10):798-806. doi: 10.1007/s005350200133.
This study examined the usefulness of magnifying videoscopic pit-pattern diagnosis in the differential diagnosis of colonic neoplasms. The relationship between pit patterns and the three-dimensional configuration of the neoplastic gland was evaluated for its contribution toward an understanding of pit patterns.
A total of 3005 colorectal lesions were examined endoscopically and histopathologically. Pit patterns were classified into six types. All materials used for crypt isolation were derived from segments of 21 colorectal lesions and one normal colonic mucosa. For the crypt isolation, the HCl-digestion method was used.
The magnifying videoscopic diagnosis was comparable with the histological diagnosis in the 3005 colorectal lesions. Isolated crypts with the type-I pit pattern resembled a test-tube; the type-II pit pattern was also tubular, but had observed fissures at the bottom; the type-III l pit pattern was a reversed triangle or tongue-like in shape; and the type-III s pit pattern was columnar and either tapered off or meandered. Isolated crypts with the type-IV b pit pattern appeared as long reversed triangles with protuberances, and the type-IV v pit pattern was flat with slender tubules or finger-like processes. The isolated crypts with the type-V pit pattern were complicated and indistinct in shape.
Evaluation of the three-dimensional configuration revealed that when the pit patterns, of each isolated crypt differed, their three-dimensional configurations also differed. Recognition of the differences in the three-dimensional configuration should contribute toward both an understanding of pit-pattern diagnosis and the further development of the endoscopic diagnosis of various colorectal lesions.
本研究探讨放大电子结肠镜下凹窝形态诊断在结肠肿瘤鉴别诊断中的应用价值。评估凹窝形态与肿瘤腺体三维结构之间的关系，以助于理解凹窝形态。
对3005例结直肠病变进行了内镜及组织病理学检查。凹窝形态分为六种类型。所有用于隐窝分离的材料均取自21例结直肠病变及1例正常结肠黏膜的组织。采用盐酸消化法进行隐窝分离。
在3005例结直肠病变中，放大电子结肠镜诊断与组织学诊断结果相当。I型凹窝形态的分离隐窝形似试管；II型凹窝形态也是管状，但底部可见裂隙；III l型凹窝形态呈倒三角形或舌状；III s型凹窝形态呈柱状，逐渐变细或蜿蜒曲折。IV b型凹窝形态的分离隐窝呈带有突起的长倒三角形，IV v型凹窝形态扁平，有细长的小管或指状突起。V型凹窝形态的分离隐窝形状复杂且不清晰。
对三维结构的评估显示，每个分离隐窝的凹窝形态不同时，其三维结构也不同。认识三维结构的差异应有助于理解凹窝形态诊断以及进一步发展各种结直肠病变的内镜诊断。
