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Stomach and Intestine(Tokyo) Volume 41, Issue 5 （April 2006）

胃と腸 41巻5号（2006年4月発行）

Japanese English

今月の主題陥凹性小胃癌の診断―基本から最先端まで

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陥凹性小胃癌の診断―マクロ診断の立場から Diagnosis and Macroscopic Findings of Small Gastric Carcinoma 西倉健 ¹ , 味岡洋一 ² , 渡辺玄 ² , 樋口清孝 ^2,3 Ken Nishikura ¹ , Yoichi Ajioka ² , Gen Watanabe ² , Kiyotaka Higuchi ^2,3 ¹新潟大学大学院医歯学総合研究科分子・病態病理学分野 ²新潟大学大学院医歯学総合研究科分子・診断病理学分野 ³国際医療福祉大学保健学部放射線・情報科学科 ¹Division of Molecular and Functional Pathology, Niigata University, Graduate School of Medical and Dental Sciences ²Division of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medical and Dental Sciences ³Department of Radiological Sciences, International University of Health and Welfare キーワード：陥凹性小胃癌 , 肉眼型 , 組織分化度 , 異型度 , 粘液形質 Keyword: 陥凹性小胃癌 , 肉眼型 , 組織分化度 , 異型度 , 粘液形質 pp.741-751

発行日 2006年4月25日 Published Date 2006/4/25

DOI https://doi.org/10.11477/mf.1403100361

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要旨　ホルマリン固定材料を用いて最大径10mm以下の陥凹性小胃癌426症例460病変（5mm以下の微小胃癌194症例215病変を含む）の肉眼的特徴について，組織分化度，異型度，粘液形質の観点からそれぞれ比較検討した．分化型癌は全体の85.7％を占め，褐色調の色調を呈し（76.6％），表面には胃小区に類似した微細構造がみられた（94.2％）．一方，低分化型癌はその頻度は低いものの，褪色調の色調（87.2％），明瞭な境界（87.2％），非癌粘膜島形成（48.7％）や辺縁粘膜の切り崩し像など特徴的な所見を備えていた．また分化型癌のうち高異型度癌（51.3％）は低異型度癌（48.7％）に比較して，褐色調色調が強調される傾向がみられた．胃型形質癌は腸型形質癌と比較して，褪色調の色調を呈しやすく（43.2％ vs. 16.3％，p＜0.01），辺縁境界が不明瞭である割合が高かった（54.5％ vs. 24.5％，p＜0.01）．さらに胃型形質癌の陥凹底は顕微鏡下の実測で有意に浅く（0.34±0.09mm vs. 0.47±0.09mm，p＜0.01），境界不明瞭な要因の1つと推定された．

　The aim of this study was to clarify macroscopic findings of small-sized (10mm or less in diameter) gastric carcinomas from the viewpoint of histopathological features. We studied 460 lesions from 426 cases of small-sized gastric carcinomas, including 215 lesions from 194 cases of minute (5mm or less) carcinomas.

　Differentiated type adenocarcinomas were observed in 85.7 ％ of all cases and appeared brownish in color (76.6 ％) and with an area-like pattern on their surfaces (94.2％). 51.3％ of differentiated carcinomas were high-grade ones which were characterized in enhancement by their brownish surface color. On the other hand, poorly differentiated adenocarcinomas demonstrated unique findings such as discolored surface (87.2％), clear outline (87.2％), formation of islands (48.7 ％), and destruction of marginal mucosa.

　As for mucous phenotype, gastric phenotype carcinomas revealed a significantly higher incidence of discolored surface (43.2％) than those with the intestinal phenotype (16.3％) (p＜0.01). Carcinomas with the gastric phenotype also demonstrated a significantly higher incidence of unclear outline (54.5％) as compared with that of the intestinal phenotype carcinomas (24.5％) (p＜0.01). It was also found that mucosal heights measured under a microscope revealed that the shallowest depressions were associated with gastric phenotype lesions (0.34±0.09mm) rather than with the gastrointestinal phenotype (0.48±0.11mm) and the intestinal phenotype (0.47±0.09mm) (p＜0.01).