1）発生・発育進展―病理組織学的観点から

Development and Progression of Colorectal Cancer─Histopathological View

要旨　大腸癌の二大組織発生説である，adenoma-carcinoma sequence説とde novo発生説について，歴史学的な変遷を病理組織学的観点から概説した．それとともに，自験例の組織学的検討から大腸癌の発生・発育進展について考察した．早期癌347例の検討では腺腫成分が認められる癌が72％であり，その多くはM癌である．一方，進行癌に成りやすいSM癌では腺腫成分が認められない癌が59％と多い．大きさ3cm以下の非有茎性病変で浸潤距離が1,000μm以上のSM癌63例について検討すると，腺腫成分が認められない癌が68％であり，表面型癌由来ととらえられる癌は79％である．組織学的解析からは表面型のde novo癌が進行癌への主経路と成るととらえられた．

　The adenoma-carcinoma sequence and the de novo cancer theory are two major theories of the carcinogenesis of colorectal cancer. In this paper the historic change in those opinions are reviewed. We examined 347 cases of early colorectal cancers histopathologically, and estimated the carcinogenesis and developmental process of colorectal cancers are estimated. Most cases of M cancers were carcinoma with adenoma components. On the other hand, 59% of cases of SM cancers were carcinoma without adenoma. In 63 cases of SM cancers, which were non-pedunculated, less than 3cm in size and with invasion depth of more than 1,000μm, 68% of cases were carcinoma without adenoma, and 79% of cases had arisen from superficial type carcinoma. From the data obtained, it is considered that the de novo cancers of superficial type are the major lesions that develop into advanced cancers.