Miyamoto Hideaki, Ikematsu Hiroaki, Fujii Satoshi, Osera Shozo, Odagaki Tomoyuki, Oono Yasuhiro, Yano Tomonori, Ochiai Atsushi, Sasaki Yutaka, Kaneko Kazuhiro
Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa City, Chiba, 277-8577, Japan.
Int J Colorectal Dis. 2014 Sep;29(9):1069-75. doi: 10.1007/s00384-014-1931-x. Epub 2014 Jul 3.
Laterally spreading tumors (LST) have been recognized worldwide. The aim of our retrospective study was to evaluate the clinicopathological differences of LST arising in the colon and rectum.
We investigated the clinical records of consecutive patients with LST that were endoscopically or surgically resected at our hospital between February 2006 and March 2011. LST were classified into three types: granular-homogenous (LST-GH), granular-nodular mixed (LST-GM), and nongranular (LST-NG) types. We also defined the hardly elevated flat lesion with a dilated pit pattern that occurs at the margins of LST as the "skirt." The clinicopathological characteristics of the LST arising in the colon and rectum, including the presence of the skirt, were compared.
A total of 496 colorectal LST in 435 patients were examined. LST-GM was predominant in the rectum, whereas LST-NG was predominant in the colon (p < 0.001). The mean tumor size was larger in the rectum (39.3 ± 17.9 mm) than the colon (25.8 ± 13.6 mm) (p < 0.001). Low-grade dysplasia frequency was lower in the rectum than the colon (4 vs. 37%, p < 0.001). The skirt was identified in 15 lesions (3.0%), with a higher incidence in the rectum than the colon (17 vs. 0.5%, p < 0.001). The skirt was found only in LST-GM.
A greater proportion of LST-GM, greater mean size, and lower incidence of low-grade dysplasia were found in rectal LST. The skirt was a novel and unique finding, primarily observed in rectal LST-GM cases.
侧向发育型肿瘤（LST）已在全球范围内得到认可。我们这项回顾性研究的目的是评估发生于结肠和直肠的LST的临床病理差异。
我们调查了2006年2月至2011年3月期间在我院接受内镜或手术切除的连续性LST患者的临床记录。LST分为三种类型：颗粒均匀型（LST-GH）、颗粒结节混合型（LST-GM）和非颗粒型（LST-NG）。我们还将LST边缘出现的伴有扩张性凹陷模式的几乎不隆起的扁平病变定义为“裙边”。比较了发生于结肠和直肠的LST的临床病理特征，包括裙边的存在情况。
共检查了435例患者的496个结直肠LST。LST-GM在直肠中占主导，而LST-NG在结肠中占主导（p＜0.001）。直肠中LST的平均肿瘤大小（39.3±17.9mm）大于结肠（25.8±13.6mm）（p＜0.001）。直肠中低级别异型增生的发生率低于结肠（4%对37%，p＜0.001）。在15个病变中发现了裙边（3.0%），直肠中的发生率高于结肠（17%对0.5%，p＜0.001）。裙边仅在LST-GM中发现。
直肠LST中LST-GM的比例更高、平均大小更大且低级别异型增生的发生率更低。裙边是一个新的独特发现，主要见于直肠LST-GM病例。
