Korekawa Kai, Shimoyama Yusuke, Fujishima Fumiyoshi, Nagai Hiroshi, Naito Takeo, Moroi Rintaro, Shiga Hisashi, Kakuta Yoichi, Kinouchi Yoshitaka, Masamune Atsushi
Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan.
Clin Endosc. 2024 Sep;57(5):637-646. doi: 10.5946/ce.2024.027. Epub 2024 Jun 21.
BACKGROUND/AIMS: During endoscopy, white spots (WS) are sometimes observed around benign or malignant colorectal tumors; however, few reports have investigated WS, and their significance remains unknown. Therefore, we investigated the significance of WS from clinical and pathological viewpoints and evaluated its usefulness in endoscopic diagnosis.
Clinical data of patients with lesions diagnosed as epithelial tumors from January 1, 2019, to December 31, 2020, were analyzed (n=3,869). We also performed a clinicopathological analysis of adenomas or carcinomas treated with endoscopic resection (n=759). Subsequently, detailed pathological observations of the WS were performed.
The positivity rates for WS were 9.3% (3,869 lesions including advanced cancer and non-adenoma/carcinoma) and 25% (759 lesions limited to adenoma and early carcinoma). Analysis of 759 lesions showed that the WS-positive lesion group had a higher proportion of cancer cases and larger tumor diameters than the WS-negative group. Multiple logistic analysis revealed the following three statistically significant risk factors for carcinogenesis: positive WS, flat lesions, and tumor diameter ≥5 mm. Pathological analysis revealed that WS were macrophages that phagocytosed fat and mucus and were white primarily because of fat.
WS are cancer-related findings and can become a new criterion for endoscopic resection in the future.
背景/目的：在内镜检查过程中，有时会在良性或恶性结直肠肿瘤周围观察到白斑（WS）；然而，很少有报告对WS进行研究，其意义仍不明确。因此，我们从临床和病理角度研究了WS的意义，并评估了其在内镜诊断中的实用性。
分析了2019年1月1日至2020年12月31日诊断为上皮性肿瘤患者的临床资料（n = 3869）。我们还对接受内镜切除的腺瘤或癌进行了临床病理分析（n = 759）。随后，对WS进行了详细的病理观察。
WS的阳性率在包括进展期癌和非腺瘤/癌的3869个病变中为9.3%，在仅限于腺瘤和早期癌的759个病变中为25%。对759个病变的分析表明，WS阳性病变组的癌症病例比例和肿瘤直径均高于WS阴性组。多因素logistic分析显示以下三个具有统计学意义的致癌危险因素：WS阳性、扁平病变和肿瘤直径≥5 mm。病理分析显示，WS是吞噬脂肪和黏液的巨噬细胞，主要因脂肪而呈白色。
WS是与癌症相关的表现，未来可能成为内镜切除的新标准。
