Junjiro Kamiya

Small “flat adenoma” of the large bowel with special reference to its clinicopathologic features

Thirty-three small “flat adenomas,” not more than 1 cm in diameter, were collected from surgically and colonoscopically removed specimens, and their colonoscopic and histologic characteristics were described. There were 14 adenomas with mild atypia, five with moderate atypia, 14 with severe atypia (or focal carcinoma limited to the mucosa). The grade of atypia seems to increase with the size of lesions, and these lesions were assumed to play an important role in the adenoma-carcinoma sequence. The importance of recognizing the presence of these small “flat adenomas” in everyday practice is stressed.

Colonoscopic polypectomy in diagnosis and treatment of early carcinoma of the large intestine

Histologic investigation and analysis of 370 polyps, removed via colonoscope, demonstrated a malignancy rate of adenomas of about 20 per cent. Even small adenomas under 1 cm in diameter were found to have a higher malignant potential than previously appreciated. The malignancy rate was higher with increasing size, and adenomas in females had a much higher malignant potential than in males. It is obvious that colonoscopic polypectomy is valuable in detecting and treating early carcinomas of the colon.

Gardner's syndrome associated with periampullary carcinoma, duodenal and gastric adenomatosis

A 48-year-old man with Gardners syndrome, who had abdominoperineal resection for rectal carcinoma in 1962, was found to have an ulcerating growth of the duodenum, and pancreaticoduodenectomy was performed in 1979. Histologic examination by complete step-serial sectioning disclosed a well-differentiated adenocarcinoma with adenomatous remnants, a large adenoma with focal carcinoma, 256 adenomas of the duodenum, and 91 adenomas of the gastric antrum. The world medical literature was reviewed, and 29 cases of periampullary carcinoma and 12 cases of gastric carcinoma complicating familial polyposis coli or Gardners syndrome were analyzed.

Morphogenesis of human colonic cancer

A total of 155 early carcinomas, collected from colonoscopic polypectomy cases, surgically removed specimens, and resected colon from patients with adenomatosis coli, were histologically investigated in order to find their characteristic morphologic features. The commonest types of early carcinomas examined had a short stalk or were broad-based, and carcinomas 1 to 2 cm in diameter were the largest in acutal number, although the malignancy rate increased with increasing size. The malignancy rate of small adenomas, under 1 cm in diameter, is higher than previously estimated. The clinical importance of the shape and size of such polyps is stressed for earlier detection of carcinomas of the colon, and an improved concept of the morphogenesis of colonic carcinoma is proposed.

Histopathologic comparison of colorectal adenomas in English and Japanese patients

Histopathologic comparison of colorectal adenomas removed at St. Marks Hospital, London, England, and those removed at the University of Tokyo, Japan was performed. There were 1242 lesions in the St. Marks series and 310 in the University of Tokyo series. All adenomas were removed either by colonoscopic polypectomy or hot biopsy. The indications and methods of colonoscopic removal were similar in the two series. Age distribution of the patients showed a younger peak incidence in the University of Tokyo series compared with the St. Marks patients. The percentage of adenomas larger than 1 cm, of tubulovillous or villous type, and with moderate or severe dysplasia were greater in the St. Marks series than in the University of Tokyo series. Percentages of adenomas with mild, moderate, or severe dysplasia in each category of size did not differ between the two series. In view of the fact that there is a high colorectal cancer risk in England and medium cancer risk in Japan, our results give further epidemiologic support to the concept of the adenoma-carcinoma sequence.

Clinicopathological study of white spots of the colonic mucosa around polyps, with special reference to the endoscopic diagnosis of invasive carcinoma

White spots were observed on the mucosa immediately adjacent to polyps and carcinomas; the majority of the polyps proved to be carcinoma in situ or had invasive carcinoma. The white spots consisted of accumulations of foamy cells with features similar to muciphage.

RESULTS OF SURGICAL TREATMENT OF IDIOPATHIC INFLAMMATORY BOWEL DISEASE

教室における潰瘍性大腸炎およびCrohn病の手術適応ならびに術後成績について述べた. 潰瘍性大腸炎は基本的には内科的には治療すべき疾患であるが, 手術が必要な場合にもできる限り直腸を温存する手術を選択すべきであり, それが可能であると考えられた. 残存直腸の炎症再燃の治療にはステロイド坐薬が有効であった. 教室における直腸温存術8例の成績は良好で再手術を行った例はなかった.Crohn病に対する手術は狭窄, 瘻孔などの合併症に対して行われることが多かった.教室における手術成績は11例中再発率36%, 死亡率18%で, 死亡が再発に関係していたと仮定すれば再発率は54%になる. Crohn病の手術適応, 術式選択にはいまだ問題点が多く, 今後症例を集積して再検討する必要があると考えられた.

SPHINCTER-PRESERVING OPERATION FOR RECTAL CANCER WITH SPECIAL REFERENCE TO THE CHOICE OF ANTERIOR RESECTION

下にこの疑間に対する解答を探ってゆきたいと思う. 2.括 約筋温存術式の種類 括約筋温存術式には,病 変の位置と性状によって様々 な術式がある。1)内 視鏡的ポリープ摘除術,2)経 肛 門的腫瘍切除術,3)経 括約筋的腫易切除術,4)質 通 術,5)前 方切除術などがそれである. 内視鏡的ポリープ摘除術は,有 茎性,亜 有茎性の病変 に対して行われる。摘除生検として摘除した病変を組織 学的に検索した結果,mま たは Smの 癌で あることが 判明する場合が多く,結 果的に括約筋を温存した治療が 行われることになる.中 央に潰瘍性陥凹のある無茎性病 変には,多 くの場合適応がない。 経肛門的腫瘍切除術は,下 部直腸の隆起性腫痛,内 視 鏡的に摘除不可能なほど大きな腫瘤 (大きな織毛腺腫な ど),小 さな潰瘍型の痛で,患 者の全身状態が悪い場合, などに行われる。全層ならびに壁周囲リンパ節も一緒に 切除することができるが,癌 に対する手術としてはあく まで姑息的な術式である。 経括約筋的腫瘍切除術では,内外括約筋を切 り離し,直 腸壁を切 り開いて,腫 瘍を直視下に見ながら,直 腸壁全 層を合め周囲リンパ節とともに腫瘍を切除する。良性病 変のみならず,症 例を選択すれば癌に対しても根治的な 術式となりうる。イギリスの York Masonは 180例余の 直腸癌に対する括約筋温存術の適応について