대장암처럼 보인 거치상 선종 1예
A Case of Serrated Adenoma Presenting as Colon Cancer
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거치상 선종은 대장종양의 독특한 형태 중 하나로서 증식성 용종에서 관찰되는 톱니바퀴의 선구조에서 증식하는 비정형 핵을 가지는 단일 세포군으로 구성된 종양성 병변으로 정의한다. 거치상 선종은 내시경소견이나 병리학적으로 증식성 용종과 구별이 어려운 경우가 많다. 증식성 용종은 양성병변인 반면에 거치상 선종은 선종과 동일한 악성경향이 있으며, 증식성 용종에서 선암으로 진행되는 중간단계라고 제안되면서 주목을 받고 있다. 따라서 거치상 선종과 증식성 용종의 감별이 필요하며 내시경 시술자와 병리의사의 주의를 요한다. 거치상 선종은 대개 0.5 cm 이하의 작은 융기무경형이나 표면융기형 용종 형태를 취한다. 저자들은 선암과 같은 돌출형 종괴 병변이 대장내시경 조직검사에서 증식성 용종으로 진단되었으나 수술 후 거치상 선종으로 확진된 증례를 경험하였기에 문헌고찰과 함께 보고한다.
Abstract
Serrated adenoma (SA) is a distinct form of colorectal neoplasia and it is defined as a neoplastic lesion composed of a monotonous cell population with atypical nuclei proliferating in serrated glandular architectures. Hyperplastic polyp is considered a benign lesion with no malignant potential. However, SA progressed into frank carcinoma has been demonstrated in an individual case, and 'serrated neoplasia pathway' is suggested by some authors as an alternative to classical adenoma-carcinoma sequence. Distinguishing between hyperplastic polyp and SA is important because of the different management implications and the increased potential for neoplastic progression in the latter, but sometimes it is very difficult. SA is usually small and sessile polypoid lesion. We report a case of SA presenting as large fungating mass similar to colon cancer, diagnosed as hyperplastic polyp initially by colonoscopic biopsy and confirmed as after SA the surgery.
참고문헌 (20)
- "Dysplastic and malignant areas in hyperplastic polyps of the large intestine", 21, pp.138~142 (1989)
- "Mixed hyperplastic adenomatous polyps--an underdiagnosed entity.Report of a case of adenocarcinoma arising within a mixed hyperplastic adenomatous polyp", 8, pp.551~556 (1984)
- "Mixed hyperplastic adenomatous polyps", serrated adenomas.A distinct form of colorectal neoplasia, 1990, pp.14, 524~537
- "The histologic and colonoscopic features and p53 protein overexpression of serrated adenoma", 39, pp.350~355 (2002)
- "Serrated adenoma의 β-catenin bcl-2 및 cox-2 발현양상" (2004)
- "The serrated neoplasia pathway", 34, pp.548~555 (2002)
- "Emerging concepts in colorectal neoplasia", 123, pp.862~876 (2002)
- "Proliferative activity of mixed hyperplastic adenomatous polyp", serrated adenoma in the large intestine measured by PCNA, jgastroenterol1996, 207~213
- "Three-dimensional reconstruction and fractal geometric analysis of serrated adenoma", 93, pp.259~266 (2002)
- "Serrated adenoma:a clinicopathological,DNA ploidy,and immunohistochemical study", 20, pp.1141~1147 (2000)
- "Serrated adenoma-a little known type of colorectal tumors", 135, pp.21~24 (1994)
- "Cellular differentiation status of epithelial polyps of the colorectum:the gastric foveolar cell-type in hyperplastic polyps", 42, pp.357~364 (2003)
- "Immunohistochemical staining patterns of MUC1 and MUC5AC mucins in hyperplastic polyps and traditional adenomas of the colorectum", serrated ade(mas), pp.1039~1048
- "Differences in the distribution of acidic mucins between flat tubular adenomas and flat serrated adenomas of the colorectal mucosa", 10, pp.383~388 (1996)
- "Apoptosis index and apoptosis-related antigen expression inserrated adenoma of the colorectum:the saw-toothed structure may be related to inhibition of apoptosis", 26, pp.249~256 (2002)
- "Comparison of cyclo-oxygenase 2 expression in colorectal serrated adenomas to expression in tubular adenomas and hyperplastic polyps", 17, pp.144~149 (2002)
- "Infrequent APC mutations in serrated adenoma", 193, pp.181~186 (2001)
- "No major tumorigenic role for beta-catenin in serrated as opposed to conventional colorectal adenomas", 89, pp.152~157 (2003)
- "Infrequent K-ras codon 12 mutation in serrated adenomas of human colorectum", 42, pp.680~684 (1998)
- "Frequent p53 gene mutations in serrated adenomas of the colorectum", 186, pp.131~139 (1998)