早期胃癌の治療法を左右する病理所見―リンパ節転移陽性sm胃癌の特徴

The Pathological Features of Submucosal Invasive Gastric Carcinoma Accompanied with Lymph Node Metastasis

要旨　胃sm癌377例のリンパ節転移と性，大きさ，占居部位，組織型，粘液形質，内分泌顆粒，潰瘍または潰瘍瘢痕などについて検討した．その結果，リンパ節転移率は女性にやや多い．占居部位では有意差をもって口側で少なく肛門側で高かった．組織型では，未分化癌と乳頭状腺癌で高く，高分化腺癌で低かった．また，胃型形質発現例で高かった．潰瘍または潰瘍瘢痕例で高かった．これらのリンパ節転移率の高い傾向のある症例は，EMR施行前m癌と診断し施行後smと診断された場合，リンパ節郭清を含む手術が必要と思われる．なお，リンパ管，静脈侵襲とリンパ節転移の検討は，CD34染色およびEVG染色を行ったが，それでも診断が非常に困難で主観が入る恐れがあるので今回の検討から除外した．

　To assess the risk factors against lymph node metastasis of submucosal invasive gastric carcinoma, the size, the location, the histological type, the presence of peptic ulcer or ulcer scar, the phenotype by immunohistochemical method, and the depth of invasion of the gastric carcinoma were investigated. The features of submucosal invasive carcinomas with lymph node metastasis were: ( 1 ) large size, ( 2 ) located in the lower region of the stomach, ( 3 ) lesions containing foci with poorly differentiated adenocarcinoma and papillary adenocarcinoma, ( 4 ) lesions accompanied peptic ulcer or ulcer scar, ( 5 ) HGM positive finding by immunohistological staining, ( 6 ) showing massive invasion of the carcinoma into the deeper submucosal layer. Therefore, if submucosal invasive gastric carcinoma has the above stated features, gastrectomy with lymphadenectomy is recommended.