早期胃癌病型に類似した病巣をもった進行胃癌（早期類似進行胃癌）の病理組織学的検討

Pathological Aspects of Early Simulating Advanced Carcinoma of the Stomach

　肉眼所見が早期胃癌病型に類似しておりながら，癌が固有筋層（pm）以下に深達しているものは，種々の名称で呼ばれているが¹⁾²⁾，筆者ら³⁾は以前より早期類似進行癌（以下「類進癌」と略す）と称してきた．これら類進癌の臨床的所見，予後などについては幾つかの報告¹⁾⁴⁾があるが，その病理組織学的な検討はほとんどなされていないので，この点の考察を行った．

対象

　Table 1のように1974年末までの13年半の間に大阪成人病センターにおいて胃切除された胃癌1,446例中，その病巣が肉眼的に早期癌病型でしか表現できないような深達癌114例を類進癌として検討した．対照としては，早期癌548例と，Borrmann型の進行癌（以下「Borrmann癌」と略す）674例について，比較検討した．また，類進癌とBorrmann癌との中間の病型（以下「類進・Borrmann中間型」と略す）110例も比較検討に加えた．

なお癌病巣を2つ以上もった症例は，そのうちの主癌病巣についてのみ検討した．

　One-hundred and fourteen cases of gastric carcinoma invading beyond proper muscle layer with the lesion macroscopically simulating early gastric carcinoma were studied on histo-pathological findings, together with 548 cases of early carcinoma and 684 advanced carcinoma classified by Borrmann's criteria as controls.

　In regard to macroscopical types, the early simulating advanced carcinoma had mostly depressed type with co-existing ulcer and no case of flat type was observed. A volume of cancerous tissues in the deepest layer of the gastric wall was smaller in the early simulating advanced carcinoma than in advanced carcinoma of Borrmann's classification, resulting from findings of macroscopic and microscopic pattern of cancer invasion in the gastric wall. Prognosis of the early simulating advanced carcinoma was as favorable as that of early carcinoma, and far better than advanced carcinoma of Borrmann's classification.

　Pattern of cancer invasion in the gastric wall was classified into four types; ①micro-invasion type, ②localized infiltration type, ③diffuse infiltration type and ④type of metastasis by vessels. In the early carcinoma and the early simulating advanced carcinoma, micro-invasion type was more frequently observed and diffuse infiltration type was less frequently seen than in the advanced carcinoma. In the early simulating advanced carcinoma, degree of lymph node metastasis ascended in the types of ①, ②, ③ and ④ in this urder, and postoperative 5-year survival of microinvasion type was high and that of diffuse infiltration type was the worst.