胃sm癌の病理―内視鏡的治療の可能性および根治性の検討

The Pathological Evaluation of Gastric sm-cancer

要旨　胃sm癌の外科的切除症例159例と，内視鏡的切除症例15例を検討した．リンパ節転移の有無でsm癌を評価すると，転移の可能性が低い条件は，①最大径1cm未満，②分化型の組織型で未分化型の要素を含まない，③顕微鏡的にもごく微量の浸潤，④リンパ管侵襲像を認めない，であった．これによりsm癌の内視鏡的粘膜切除術の根治性を考えると，臨床的には粘膜内癌と区別できない病変で，一括切除がなされ，適切な病理学的検索により初めて微量浸潤を見いだした分化型癌の症例のみ根治性ありと容認しうる．臨床的にsm癌とわかる症例は容認しえない．

　We examined 159 cases of gastric sm-cancers obtained by surgical resection and 15 cases by endoscopic mucosal resection (EMR). As a result, the characteristics of sm-cancers without lymph node metastasis are as follows; 1) Diameter is less than 1 cm. 2) Histologically differentiated and not accompanied with undifferentiated elements. 3) Microscopically minute invasion, and 4) No lymphatic invasion. Therefore, we agree that sm-cancers are curable by using EMR, on condition that clinically they are intramucosal, resected en bloc, and that they are histologically differentiated lesions. But we can't agree that EMR is an effective cure for those clinically detectable sm-cancers not fulfilling the conditions mentioned above.