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要旨 内視鏡的・外科的に切除された大腸sm癌41例について,①H・E染色像による組織学的再評価(modified Gleason's grading system):前立腺癌のGleason分類を応用した組織学的分化度のスコア化(低いものから,A群,B群,C群に分類),②接着因子であるE-cadherinとβ-cateninの免疫組織学的検討を行った.組織学的再評価では,従来の方法では高分化腺癌とされる病変の中にもスコアB群・C群のものがあり,再評価結果はリンパ管侵襲,リンパ節転移と相関した.大腸sm癌における接着因子の検討では,発現消失や核内・細胞質への発現などの異常を示した.これらの接着分子の正常な細胞膜への発現が保持されている病変では,脈管侵襲,リンパ節転移ともに頻度が低かった.従来の大腸癌分化度の評価に比べて,modified Gleason's grading systemは臨床病理学的な因子とより相関したが,接着分子の膜への局在の消失をみることで,更に的確な転移高危険群の選択が可能となることが示唆された.
Clinicopathological and immunohistochemical studies were carried out on 41 cases of submucosal-invasive colorecal carcinoma. Histopathological score was graded into five patterns (Score 1~5) according to the degree of grandular differentiation and stromal fibrosis. Tumors were classified into three groups by according to 3rd histological scores as follows : group A (total score 3~6), group B (total score 7~10), group C (total score 11~15) . According to this grading system, group B and C showed a higher metastatic potential than group A. Furthermore, we examined the immunoreactivity of adhesion molecules (E-cadherin, β-catenin) and p53 protein of the submucosal-invasive colorecal carcinoma. In cases with decreased membranous expression of E-cadherin and β-catenin, the incidence of vascular permeation or lymph-nodal metastasis was higher than in those with preserved membranous expression of E-cadherin and β-catenin. Groups B and C showed a significantly higher incidence of decreased membranous expression on adhesion molecules than group A. These results suggest that this grading system is a valuable means for providing more clinicopathological information, and decreased membranous expression of adhesion molecules may reflect dysfunction of the cell-cell adhesion system. The immunoreactivity of adhesion molecules is a factor indicating the metastatic potential of the submucosal-invasive colorectal carcinoma.
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