The Origin of Is Type of Submucosal Invasive Carcinoma, Seen from Histopathlogical Analysis of Its Glandular Structure Yasuo Ohkura 1 1Department of Pathology, Tokyo Metropolitan Cancer Detection Center Keyword: Is型大腸sm癌 , 組織構築 , 組織学的表面型 , 組織学的隆起型 , 発育進展過程 pp.1479-1488
Published Date 1997/10/25
DOI https://doi.org/10.11477/mf.1403105225
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 The height of Is type of Submucosal invasive carcinoma involves two different elements; mucosal thickness and Submucosal invasion. Sixty-two cases of Is type of submucosal invasive carcinomas with mucosal spreading area were divided into three groups according to mucosal height. They were histopathologically flat type (F type) less than 2 mm in height, histopathologically protruded type (P type) more than 3 mm in height, and intermediate type (I type) with a height between 2 and 3 mm. Histologically, the glandular structure, differentiation, nuclear atypia, loss of mucosa by cancer invasion and accompaniment with adenomatous components were examined according to tumor size and invasive depth, and comparison was made between the mucosa and the submucosa. The histological figure of the submucosa had basically the same glandular structure as the mucosa, but was differentiated with higher grades of atypicality. Examined in these histopathological subgroups divided by mucosal height, histopathological differentiation between F type and P type was revealed as follows. 1) F type was a small but much more invasive cancer, and P type was large but much less invasive. 2) The categorization of P type was mostly well-differentiated adenocarcinoma, but that of F type was mixed with moderately differentiated adenocarcinoma modified by increase of size and invasion depth. 3) The glandular structure of F type was mainly tubular pattern, and its of P type was villotubular pattern. 4) Nucleori in the submucosa of F type had a high grade of atypia, but those of P type were mixed with a low grade of atypia. 5) F type showed a tendency to be accompanied with mucosal destruction brought on by cancer invasion. 6) Most of F type were without adenomatous components, but 60% of P type were accompanied by adenomatous components. 7) Minute cancer nests, which are associated with metastasis to the small vessels, were more prevalent among F type than P type. Histological features of I type were between F type and P type, but closer to F type. From these results different developmental courses for F type and P type can be presumed. F type arise from flat early carcinoma of tubular pattern and are made to protrude by invasion of the submucosa and the accompanying fibrosis. In contrast with this, P type develop according to the mucosal thickness of their villotubular pattern and then with submucosal invasion. In the Is type of submucosal invasive carcinomas, about 60% were F type, so it was supposed that most of the advanced carcinomas developed from flat type of carcinoma. The histopathological analysis of glandular structure is needed in the study of the development of colonic carcinoma.

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