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要旨 従来より言われているpre-linitis plastica型胃癌の前段階,つまりその初期病変を知る目的で,胃底腺粘膜を母地とするⅡcまたはⅡb型未分化型早期胃癌135症例136病変〔M癌77症例(78病変),SM癌58症例(58病変)〕の手術症例について,臨床病理学的および免疫組織化学的立場から検討した.①対象とした早期胃癌は病理組織学的に背景粘膜における萎縮の程度が軽度であるほど腫瘍径が小さく,粘膜内における腫瘍径が小さいほど潰瘍合併率が低かった.②粘膜内癌巣に線維化を伴う病変がM癌で3病変,SM癌で1病変,計4病変存在したがいずれも潰瘍合併は欠いていた.このうちSM癌は原発巣より粘膜下層の浸潤が広く,従来より言われているpre-linitis plastica型胃癌と言える症例であった.③免疫組織化学的にスキルス胃癌において発現が著しいとされているTGF-βは潰瘍合併のない34病変(M癌17病変,SM癌17病変)中,粘膜内癌巣に線維化を認めたM癌の1病変のみに陽性であった.以上の結果から,胃底腺粘膜に発生する未分化型癌は粘膜内進展において癌周囲粘膜の萎縮の程度に左右され,粘膜内癌巣に線維化を認める症例はlinitis plastica型胃癌の初期病変となりうると推察された.
Using 136 undifferentiated type early gastric cancers (m:78 cases and sm:58 cases) of Ⅱc and Ⅱb lesion that had developed in the fundic gland mucosa, we investigated the histochemical and immunohistochemical background mucosa of cancer, the intramucosal size of cancer and its accompanying ulcerarion. We also discussed the pre-stage of so-called pre-linitis plastica type gastric cancer.
The results were as follows; (1) Histochemically, the more mild the degree of the atrophy of the background mucosa was, the smaller the tumor size was, and the smaller the tumor size was, the lower the rate of its accompanying ulceration became. (2) In the total of 136 cases, intramucosal fibrosis was recognized only in 3 cases of mucosal cancer and 1 case of submucosal cancer. In the sm case, the submucosal invasion area was wider than that of the intramucosal invasion area so this case corresponds with so-called pre-linitis plastica type gastric cancer. (3) In the early gastric cancers without accompanying ulceration (m:17 cases and sm:17 cases), only one mucosal cancer case, which showed fibrosis in the area of the carcinoma, was immunohistochemically positive for TGF-β.
Conclusion;Intramucosal development of undifferentiated type cancer that has developed in the fundic gland mucosa depends upon the degree of mucosal atrophy of the surrounding area of the cancer lesion, and some cases with intramucosal fibrosis of gastric cancer were considered to be the initial stages of so-called linitis plastica-type gastric cancer.
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