胃癌の病理学的研究の進歩と臨床との接点

Progress of Gastric Research and Its Clinical Implication

　1990年代になり日欧米間における消化管腫瘍の組織診断名のすりあわせが行われ，high grade adenoma/dysplasiaとnon invasive intramucosal cancerは同じであると合意がなされた．その結果今後は，早期胃癌の国際比較が統一された分類で行われることが可能となった．また胃癌は形質発現の違いから，胃型形質癌，腸型形質癌，混合型形質癌に分類され，それらと胃癌発生，発育進展との関係，さらには臨床的な接点について述べた．

　Histological diagnostic criteria of gastricintestinal epithelial neoplasia is large differences between Japanese and Western gastrointestinal pathologists. Consensus meeting was held in 1996 and 1999, high grade adenoma/dysplasia in Western countries and non invasive intramucosal carcinoma by Japanese pathologists were agreed as same category, and Vienna classification of GI epithelial neoplasia was proposed.

　Hereafter, it is possible inernational comparable study of early gastrointestinal tumor will be done based on same classification. From analyses of phenotypic expressions of gastric cancer, gastric cancer are classified into three types ; carcinoma with gastric phenotype, intestinal phenotype and gastric and intestinal phenotype. The differences of phenotypic expression are correlated with histogenesis, development, clinical features and biological behavior of gastric carcinoma.