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要旨 4型(びまん浸潤型)大腸癌の病理学的な特徴を明らかにするために,術前未治療の4型大腸癌の外科的切除材料を,その浸潤形式からlinitis plastica型,癌性リンパ管症型および粘液結節型の3群に分類し,以下の諸項目について比較検討した.検討項目は①癌巣の大きさ,組織型,壁深達度,脈管侵襲およびリンパ節転移,②浸潤部における間質線維増生の程度,固有筋層構造の保存状態,③癌部,非癌部における腸壁の厚さである.各浸潤形式間の病理学的類似点としては,腸壁を水平および垂直方向に広範囲かつびまん性に浸潤増殖することにより,一定区間の全周性壁肥厚を必発すること,深達度は全例が固有筋層以深で,脈管侵襲,リンパ節転移を高頻度に伴うことが挙げられた.一方,相違点としてはlinitis plastica型の群は低分化型腺癌と印環細胞癌が,癌性リンパ管症の群は分化型腺癌が,粘液結節型の群は分化型腺癌と印環細胞癌が主たる組織型であること,linitis plastica型と癌性リンパ管症型の2群は浸潤部固有筋層構造は比較的よく保存されているが,粘液結節型の群は固有筋層は破壊され,その構造は消失していることが挙げられた.以上の解析結果から4型大腸癌には3種類の浸潤形式があり,浸潤部の組織型は分化型腺癌主体のものから,低分化型腺癌,印環細胞癌主体のものまで様々であるが,共通して腸壁を広範囲かつびまん性に浸潤し,高度の全周性壁肥厚を来すことが明らかになった.
Twenty-four lesions of diffusely infiltrating (type 4) primary colorectal carcinomas from 24 patients without preoperative treatment were studied histopathologically to analyze differences and similarities between the three modes of carcinoma-invasion. The type 4 primary colorectal carcinomas were collected from 1962 through 2000 and were classified as follows: 9 carcinomas of linitis plastica type, 8 carcinomas of lymphangiosis carcinomatosa type, and 7 carcinomas of muconodular type.
The following conclusions were obtained.
(1) Type 4 primary colorectal carcinomas were very rare.
(2) Most of the patients with type 4 primary colorectal carcinomas were found at a late stage of the disease (e.g., directly invading other organs, peritoneal dissemination, and distant metastsis).
(3) Type 4 primary colorectal carcinomas infiltrated laterally and vertically irrespective of their mode of infiltration. The colorectal wall in type 4 primary carcinomas was markedly thickened along the long segment and its lumen was stenotic.
(4) Histologically, carcinomas of linitis plastica type showed the morphological features of poorly differentiated adenocarcinoma and/or signet-ring cell carcinoma. Carcinomas of lymphangiosis carcinomatosa type consisted of differentiated adenocarcinoma, while carcinomas of muconodular type consited of differentiated carcinoma and/or signet-ring cell carcinoma.
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