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A Pathological Study of Submucosal lnvasive Cancer of the Colon and Rectum: Special Reference to Diagnosis of Submucosal Invasive Cancer Masahiro Ikegami 1 , Tadakazu Shimoda 1 , Jiro Watari 2 , Takaaki Ishii 1 , Shigeo Koido 1 1Department of Pathology, The Jikei University School of Medicine 2Foundation for Detection of Early Gastric Carcinoma Keyword: 大腸癌 , 表面型 , 肉眼診断 , sm浸潤度 pp.776-786
Published Date 1991/7/25
DOI https://doi.org/10.11477/mf.1403102584
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 Macroscopical diagnosis of superficial colorectal cancer which showed submucosal invasion was studied. Superficial colorectal cancer was defined as that the absolute height of the lesion was less than 3 mm. Colorectal cancers were classified into two groups:Those accompanied by intramucosal polypoid growth (PG-ca) and those with non-polypoid growth (NPG-ca). Ninety nine lesions (68.8%) were PG-ca, while 45 lesions (31.3%) were NPG-ca. In the measurement value of the area of invasive cancer tissue in the submucosal layer, there was no difference between PG-ca and NPG-ca.

 On the other hand, however, the average maximum diameter of PG-ca was 21.O mm, while the lesions of NPG-ca with an average diameter of 11.O mm were smaller. In other words, compared with PG-ca, a characteristic of NPG-ca was that the invasive cancer area in the submucosal layer was quite large when compared with the maximum diameter of its lesion. In macroscopical classification,PG-ca showed only 3 lesions of the superficial type of cancer, while 44.4% of submucosal invasive NPG-ca were of the superficial type.

 We then discussed the fact that to make a diagnosis about the depth of invasion of NPG-ca, a morphometrical study of intramucosal and submucosal invasive NPG-ca can be of use. There was a definite correlation between the absolute height of the lesion and the degree of submucosal invasion. The heights of cancerous lesions were categorized as follows:Less than 1 mm in height-intramucosal cancer or minimal submucosal invasive cancer. Over 1 mm in height-moderate or massive submucosal invasive cancer. More than 3 mm in height-massive submucosal invasive cancer. The maximum diameter of lesions over 10 mm, usually indicated massive submucosal invasion. Many of the lesions less than 10 mm in maximum diameterindicated moderate or massive submucosal invasion. Deep depression was important evidence of invasion into the submucosal layer. Depression over 1 mm in depth indicated massive submucosal invasion. As one result of this study, we found that cancer with minimal invasion of the submucosal layer did not result in lymphatic and venous permeation. To determine whether there is moderate or massive invasion into the submucosal layer, it is important to make exact macroscopical diagnosis.


Copyright © 1991, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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