전통적 거치상샘종에서 발생한 조기 대장 샘암종 1예 = Early Adenocarcinoma Arising from Traditional Serrated Adenoma in the Colon

다국어 초록 (Multilingual Abstract)

A serrated adenoma is a precursor lesion for some cases of microsatellite unstable colorectal carcinoma (CRC). The serrated neoplasia pathway has been associated with carcinogenesis of serrated adenoma, which is different from the traditional adenoma-carcinoma sequence. The serrated neoplasia pathway accounts for 10∼15% of CRCs, and these tumors typically demonstrate microsatellite instability. Cases of a CRC arising from a serrated adenoma have been rarely identified with the recent recognition of the serrated neoplasia pathway. However, these cases are not frequently reported in Korea, because this concept has only been recently emphasized. We report a case of an early adenocarcinoma arising from a traditional serrated adenoma of the colon, which was diagnosed and treated by a colonoscopic polypectomy.

국문 초록 (Abstract)

거치상샘종은 미소위성체 불안정성을 보이는 대장 샘암종의 전구 병변이다. 거치상샘종으로부터 발생하는 대장암은 전통적인 샘종-샘암종 경로와 다른 대장암화 경로인 거치상 신생물 대장암화 경로로 악성화가 발현되는 것으로 알려져 있다. 약 10∼15%의 대장암이 거치상 신생물 대장암화를 통해 악성화하며, 미소위성체 불안전성 기전을 통해 발생한다고 알려져 있다. 거치상샘종으로부터 발생한 대장암 증례들이 최근 드물지 않게 관찰되고 있지만, 이런 개념들이 비교적 최근에 정립되었기 때문에 국내에서 보고된 예는 매우 드물었다. 저자들은 특별한 증상 없이 건강검진 목적으로 시행한 대장내시경 검사에서 구불결장의 전통적거치상샘종으로부터 발생한 대장 샘암종을 내시경 폴립절제술을 통해 확진하고 치료한 증례를 문헌 고찰과 함께 보고한다.

참고문헌 (Reference)

1 Ionov Y, "Ubiquitous somatic mutations in simple repeated sequences reveal a new mechanism for colonic carcinogenesis" 363 : 558-561, 1993

2 Hawkins NJ, "Sporadic colorectal cancers with microsatellite instability and their possible origin in hyperplastic polyps and serrated adenomas" 93 : 1307-1313, 2001

3 Snover DC, "Serrated polyps of the large intestine: a morphologic and molecular review of an evolving concept" 124 : 380-391, 2005

4 Harvey NT, "Serrated neoplasia of the colorectum" 13 : 3792-3798, 2007

5 Torlakovic E, "Serrated adenomatous polyposis in humans" 110 : 748-755, 1996

6 Noffsinger AE, "Serrated adenoma: a distinct form of non-polypoid colorectal neoplasia?" 20 : 543-563, 2010

7 Leggett B, "Role of the serrated pathway in colorectal cancer pathogenesis" 138 : 2088-2100, 2010

8 Jass JR, "Morphology of sporadic colorectal cancer with DNA replication errors. Gut 1998;42: 673-679" 42 : 673-679, 1998

9 Longacre TA, "Mixed hyperplastic adenomatous polyps/serrated adenomas. A distinct form of colorectal neoplasia" 14 : 524-537, 1990

10 Thibodeau SN, "Microsatellite instability in cancer of the proximal colon" 260 : 816-819, 1993

11 Boparai KS, "Increased colorectal cancer risk during follow-up in patients with hyperplastic polyposis syndrome: a multicentre cohort study" 59 : 1094-1100, 2010

12 Winawer SJ, "Guidelines for colonoscopy surveillance after polypectomy: a consensus update by the US Multi-Society Task Force on Colorectal Cancer and the American Cancer Society" 130 : 1872-1885, 2006

13 Rex DK, "Guidelines for colonoscopy surveillance after cancer resection: a consensus update by the American Cancer Society and US Multi-Society Task Force on Colorectal Cancer" 56 : 160-167, 2006

14 Iino H, "DNA microsatellite instability in hyperplastic polyps, serrated adenomas, and mixed polyps: a mild mutator pathway for colorectal cancer?" 52 : 5-9, 1999

15 Mäkinen MJ, "Colorectal serrated adenocarcinoma" 50 : 131-150, 2007

16 Mäkinen MJ, "Colorectal carcinoma associated with serrated adenoma--prevalence, histological features, and prognosis" 193 : 286-294, 2001

17 Garcia-Solano J, "Clinicopathologic study of 85 colorectal serrated adenocarcinomas: further insights into the full recognition of a new subset of colorectal carcinoma" 41 : 1359-1368, 2010

18 Lee SK, "Clinicopathologic findings of colorectal traditional and sessile serrated adenomas in Korea: A multicenter study" KARGER 77 : 178-183, 2008

19 Oka S, "Clinicopathologic and endoscopic features of colorectal serrated adenoma: differences between polypoid and superficial types" 59 : 213-219, 2004