胃底腺内に存在する分化型腺癌の病理学的特徴

Pathological Study of Differentiated Adenocarcinoma in Fundic Gland Region of the Stomach

要旨　胃底腺内に存在する分化型腺癌19例，21病変についてその病理学的特徴の検討を行った．胃底腺内の分化型腺癌の頻度は胃癌全体で0.5％，胃底腺内の癌で4.1％であった．またこれらは平均年齢が53.2歳と若年性で，かつ男性に多い傾向がみられた．粘液形質からは胃型腺癌が7病変（33.3％），混合型腺癌が6病変（28.6％），腸型腺癌が8病変（38.1％）で，混合型を含め胃型形質を有した癌が62％を占めていた．組織学的に胃型形質を発現した癌は腺窩上皮型粘液を有することがほとんどで，この中には粘膜内で乳頭状あるいは絨毛状腺癌を示すものがあり，肉眼的には隆起性癌が特徴であった．このほか進行癌でも胃型形質を有した癌では粘膜がよく保持され，肉眼的に粘膜下腫瘍様形態を示す癌がみられたことが特徴であった．

　Nineteen cases (21 lesions) of differentiated adenocarcinoma (DA) in almost normal fundic gland areas were examined by mucinhistochemical methods. The frequency of DA was 0.5% of all gastric carcinomas and 4.1% of carcinomas located in normal fundic gland areas. These DA were distributed in patients of younger age more frequently than in the total number of patients with differentiated-type adenocarcinomas (mean age: 53.2 years old). By mucinhistochemical examination of these DA, 7 lesions of gastric type adenocarcinomas were found. There were 8 lesions of intestinal type and 6 lesions of combined type (gastric and intestinal). There were 13 lesions (62%) of gastric and combined types which manifested gastric phenotypic expression. All the cases of gastric type adenocarcinomas contained gastric foveolar mucin detected when stained galactose oxidase-Schiff. Histology of gastric type adenocarcinomas showed characteristically villous or papillary features. The macroscopic features of these gastric type adenocarcinomas resembled polypoid or submucosal-tumor-like carcinoma which maintained the mucosal pattern without ulceration.