胃腺扁平上皮癌の臨床病理学的研究

Adenosquamous Cell Carcinoma of the Stomach─A Clinicopathologic Analysis of 23 Cases

要旨　当院での原発性胃腺扁平上皮癌23例について臨床病理学的検討を行った．平均年齢は63歳，男女比は1.6：1で通常型と同様であった．大部分はML領域に存在し，肉眼型は潰瘍形成型が大部分を占め，平均腫瘍径は7.4（0.8～20.5）cmと大きく，約90％が進行癌であった．また83％にリンパ節転移を有し1/3以上が非治癒因子を有するなど高悪性度を示し，予後は5年生存例で約22％と一般型腺癌と比べ不良であった．腺扁平上皮癌の組織発生については腺癌の扁平上皮化生が第1に考えられ，扁平上皮癌は腺扁平上皮癌の極型と考えられた．

　Twenty-three cases of primary adenosquamous cell carcinoma of the stomach were studied clinicopathologically, including 22 cases（0.14％）out of a total of 15,572 cases with all types of carcinoma of the stomach resected surgically in the last 48 years and 1case resected endoscopically in the National Cancer Research Center Hospital. The average age was 63 with male predominance of 1.6 to 1. The tumors were mostly located at the middle and lower part of the stomach, grossly showing Borrmann type 2or 3 and were 7.4cm in size on average. Almost all of the patients（83％）had lymph node metastases and more than one third of the patients received noncurative resection. These findings indicate the highly malignant potential of adenosquamous cell carcinoma. Five-year-survival rate was about 22％ for adenosquamous cell carcinoma, which is worse than that for ordinary adenocarcinomas. Considering pathological and immunohistological findings, adenosquamous cell carcinoma of the stomach probably derives from the squamous metaplasia in adenocarcinoma, and squamous cell carcinoma of the stomach is considered as an extreme type of adenosquamous cell carcinoma.