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要旨 癌組織発生の観点から,ポリペクトミーによって得られた大腸癌の臨床病理学的解析を行った.対象71個の癌は{癌 | ポリペクトミー,最大径1cm以上}と条件付けられた集合である.癌の組織診断は異型度係数を用い,de novo癌と腺腫内癌とに振り分けた.de novo癌と腺腫内癌の大きさについては,それぞれ平均13.6±3.62mm,13.1±3.01mmとほとんど差を認めなかったが,肉眼形態については前者に無茎性病変(Ⅰs,Ⅱa)が多く,後者に有茎性病変(Ⅰp)が多かった.癌組織発生別に癌腺管と粘膜筋板との関係をみると,de novo癌の癌腺管はその96%が粘膜筋板と接しているのに対し,腺腫内癌ではその60%が癌腺管と粘膜筋板との間に腺腫腺管や過形成性腺管を介していた.また粘膜下組織へ浸潤している例はde novo癌のほうが多かった.これらより,de novo癌は腺腫内癌に比して浸潤しやすい傾向があると言える.ポリペクトミー断端の組織所見についてはde novo癌の64%が断端もしくは断端近傍に癌腺管を認め,腺腫内癌のそれは24%であった,したがって,ポリペクトミーにおいて癌の遺残や再発の可能性を減少させるためには,癌組織発生を考慮した臨床的対応が望まれる.
Early colorectal carcinoma was clinicopathologically studied by examining polypectomized specimens.
Seventy one cases of early colorectal carcinoma chosen for the present study were those in which polypectomized specimens were more than 1 cm in diameter. These cases were classified into two categories using indices of atypical glands to determine histogenesis. Twenty five cases diagnosed as de novo carcinoma and 46 cases were carcinoma in adenoma.
De novo carcinoma and carcinoma in adnoma did not show any differences in size. Most of the former were, however, macroscopically found to be sessile lesions (Ⅰs, Ⅱa) while most of the latter were pedunculated lesions (Ⅰp).
In 60% of the cases of carcinoma in adenoma, hyperplastic glands and/or adenoma components could be observed between the cancer glands and the muscularis mucosae. In contrast to the above, cancers were found to touch the muscularis mucosae directly in 90% of the cases of de novo carcinoma. Infiltration into the submucosal layer was observed in 8 cases out of 25 (32%) of de novo carcinoma.
Therefore, de novo carcinoma seems to be more likely to infiltrate into the submucosal layer than carcinoma in adenoma.
Histological observation on the stump after polypectomy revealed cancer glands near or on the stumps in 20 cases out of 25 (8O%) of de novo carcinoma, and in 12 cases of 46 (26%) of carcinoma in adenoma.
These findings suggest that histogenesis of colorectal carcinoma should be indentified for determining appropriate clinical treatment. This precaution will reduce the possibility of recurrence and/or residue of colorectal carcinoma.
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