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Stomach and Intestine(Tokyo) Volume 42, Issue 11 （October 2007）

胃と腸 42巻11号（2007年10月発行）

Japanese English

今月の主題 ESD時代における未分化型混在早期胃癌の取り扱い

主題

未分化型混在早期胃癌の病理学的特徴と問題点―リンパ節転移と肉眼的特徴 Pathological Characteristics of Differentiated-type Early Gastric Carcinoma Mixed with Undifferentiated-type―Status of Lymph Node Metastasis and Macroscopic Features 渡辺玄 ¹ , 味岡洋一 ¹ , 加藤卓 ¹ , 西倉健 ² Gen Watanabe ¹ , Yoichi Ajioka ¹ , Takashi Kato ¹ , Ken Nishikura ² ¹新潟大学医歯学総合研究科分子・診断病理学分野 ²新潟大学医歯学総合研究科分子・病態病理学分野 ¹Division of Molecular and Diagnostic Pathology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan ²Division of Molecular and Functional Pathology, Niigata University, Graduate School of Medical and Dental Sciences, Niigata, Japan キーワード：胃癌 , 組織型 , リンパ節転移 , 内視鏡的治療 , 肉眼的特徴 Keyword: 胃癌 , 組織型 , リンパ節転移 , 内視鏡的治療 , 肉眼的特徴 pp.1577-1587

発行日 2007年10月25日 Published Date 2007/10/25

DOI https://doi.org/10.11477/mf.1403101208

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要旨　外科切除単発胃M癌およびSM1癌780例を対象に，純粋分化型，純粋未分化型，分化型・未分化型混在（分化型優勢と未分化型優勢）腺癌別にリンパ節転移を検討した．M癌のリンパ節転移陽性率は1.6％（11/679）で，純粋分化型に転移例はなく，分化型優勢が1.6％（1/63），未分化型優勢が11.8％（6/51），純粋未分化型が2.5％（4/160）であった．SM1癌の転移陽性率は3.0％（3/101）で，転移陽性例は全例粘膜内癌部組織型が分化型・未分化型混在（分化型優勢1例，未分化型優勢2例）であり，SM浸潤部組織型は純粋分化型2例，未分化型優勢1例であった．以上のことから，M癌，SM1癌では（粘膜内部に）未分化型を含む分化型癌にはリンパ節転移リスクがあること，分化型・未分化型混在から成る病変は未分化型の占める比率が高いものほど転移リスクも高いこと，さらに未分化型優勢は純粋未分化型に比べて高い転移リスクを有する可能性があること，が考えられた．早期癌重複および進行癌合併例を含むM癌，SM1癌1,974例の検討では，分化型・未分化型混在癌は両型いずれが優勢かにかかわらずIIc型の頻度が高く（70％以上），逆に肉眼型からはIIc型，IIb型では50mm以上の大きさで分化型・未分化型が40％以上を占めた．また，同癌の肉眼的特徴は，"純粋分化型と純粋未分化型の定型的肉眼所見を呈する領域が併存"または"病変全体が両型の肉眼所見を併せ持つ"ことであった．

　Histological type of 780 surgically resected single M and SM1 gastric carcinoma was classified into 4 subtypes; pure differentiated-type (PD), mixture of differentiated and undifferentiated-type (differentiated-type predominant; MD, undifferentiated-type predominant; MU), and pure undifferentiated type (PU), and the status of lymph node metastasis was investigated. Metastatic rate of M carcinoma was 1.6％ (11/679) and those of PD, MD, MU, PU were 0％ (0/405), 1.6％ (1/63), 11.8％ (6/51), and 2.5％ (4/160), respectively. Metastatic rate of SM1 carcinoma was 3.0％ (3/101). Their intramucosal component was MD (1/3) and MU (2/3), and their submucosal component was PD (2/3) and MU (1/3). Judging by these results, it was thought that differentiated-type M and SM1 gastric carcinoma containing the undifferentiated-type component has a risk of lymph node metastasis and that the risk of MU is higher than that of MD. Furthermore, it was suggested that MU has a higher metastatic potential than that of PU. Macroscopic type and features were investigated for 1,974 M and SM1 gastric carcinomas regardless of the co-existence of other gastric carcinoma. The major macroscopic type of both MD and MU was type IIc (more than 70％in frequency), and more than 40％of type IIc or IIb with size greater than 50 mm was shared by MD and MU. The macroscopic feature of MD and MU was that that of a lesion consisted of co-existence of area with typical macroscopic findings of PD and PU, or that the whole lesion consists of admixture of the macroscopic findings of PD and PU.