原発性肝癌に対する経カテーテル的肝動脈化学塞栓療法後の急性胃粘膜病変の病理組織学的検索

Histopathological Study on Acute Gastric Mucosal Lesions after Transcatheter Arterial Chemo-embolization in Patients with Hepatocellular Carcinoma

要旨　原発性肝癌に対する経カテーテル的肝動脈化学塞栓療法（TACE）後の急性胃粘膜病変（AGML）25症例42病変について，病理組織学的立場から検討した．42病変中，10病変が潰瘍，7病変がびらん性胃炎と組織診断された．これら17病変のうち，上皮細胞の異型は13病変（76.5％），異型線維芽細胞は11病変（64.7％），異型内皮細胞は5病変（29.4％），死生性腺管は10病変（58.8％），結合織増生は5病変（29.4％）に認められた．びらん性胃炎よりも潰瘍で上皮細胞異型は強い傾向があった．上皮細胞異型は軽いものが多かったが，中等度以上の異型を示す細胞は，多形性でくすんだ過染色性大型核と微細空胞状の比較的広い好酸性胞体を有しており，変性・壊死性変化を示す細胞も認められた．以上の結果から，TACE後のAGMLには上皮細胞，間質細胞に異型が出現する可能性が高いことを指摘し，併せて癌との鑑別点とTACE後のAGMLの成因について簡単に考察を加えた．

　Acute gastric mucosal lesions (AGML) which occurred after transcatheter arterial chemo-embolization (TACE) for hepatocellular carcinoma were histopathologically studied. Among 42 such lesions found in 25 patients, ten lesions were histologically interpreted as open ulcer and seven lesions as erosive gastritis. Epithelial atypia, atypical fibroblast, atypical endothelium, necrobiotic gland and desmoplasia were seen in 13 (76.5%), 11 (64.7%), 5 (29.4%), 10 (58.8%) and 5 lesions (29.4%) of these 17 lesions, respectively. Epithelial atypia in open ulcers was severer than that in erosive gastritis. Although epithelial atypia was mild in many lesions, atypical epithelial cells in some lesions were characterized by pleomorphic, enlarged, smudged, and hyperchromatic nuclei surrounded by variable but, frequently, abundant amounts of eosinophilic cytoplasm that was granular and finely vacuolated. Some atypical epithelial cells showed degenerative and necrotic changes, but mitotic activity was never seen.

　In conclusion, it was shown that AGML after TACE frequently causes atypia in both epithelial and stromal cells. A brief discussion was also made on the etiology of epithelial atypia and ulceration as well as differential histologic features between chemotherapeutically induced atypia and true malignant atypia.