虫垂の杯細胞カルチノイド（goblet-cell carcinoid）―杯細胞カルチノイドは本当にカルチノイド腫瘍の1 variantか？

Goblet-cell Carcinoid of the Appendix: Is This Truly a Variant of Carcinoid Tumor?

要旨　虫垂の杯細胞カルチノイドの6症例につき，臨床病理学的立場から検討した①組織学的に本腫瘍は粘液産生細胞，好銀性細胞，銀還元性細胞，粘液と銀顆粒を同時に有する細胞，Paneth細胞などの種々の成熟型細胞から構成されていたが，概して銀反応陽性細胞は少なかった．一方，②リンパ管侵襲と神経周囲浸潤は全例に，静脈浸潤は3例に認められ，6例中3例に手術時すでにリンパ節転移と回腸盲腸壁への直接浸潤がみられた．そして，③5年以上の経過観察がなされた5例中4例が5年以内に癌性腹膜炎で死亡していた．以上の結果から，本腫瘍は十分な悪性性格を有する腫瘍で，本腫瘍をカルチノイドの1 variantとするには問題があることを指摘し，併せて本腫瘍の名称に関する簡単な考察を加えた．

　Six cases of appendiceal goblet-cell carcinoids were clinicopathologically studied. On light microscopy, each tumor was composed of mature epithelial cells such as mucus-producing cells, argyrophil cells, argentaffin cells, amphicrine cells with argyrophil granules and mucus, and Paneth cells. Although silver-positive cells were found in all cases, the number of these cells varied from only a few to moderate. On the other hand, lymphatic permeation and perineural invasion were seen in all cases and venous invasion in three of the six cases. Three of the 6 cases had lymph node metastases and showed direct tumor invasion in the cecal and ileal wall at the time of first operation. Among the 5 cases followed up for over 5 years, four patients died of peritoneal carcinomatosis within 5 years after the first operation.

　In conclusion, it was shown that goblet-cell carcinoids of the appendix is potentially malignant and that it is not a variant of carcinoid tumor. A brief discussion was also made on the terminology of this tumor.