原発性の空・回腸腫瘍の病理―肉眼形態と組織像の対比

Primary Tumors of the Jejunum and Ileum: Relationship between Macroscopic and Microscopic Findings

　小腸腫瘍は発生頻度が低く，全消化管腫瘍の3～6％を占める．しかも，その60～70％は良性腫瘍で占めている．このような理由に加え，腸管は長く，複雑に走行し，管腔は狭いなどの理由で，臨床検査法が胃におけるほど十分に進歩していなかったと言えよう．

　近年，腸の炎症性疾患がわが国で注目されるようになってきた．このうち，腸結核やクローン病などは小腸に好発する病変である．これらの疾患を発見しようとする努力が一般的に払われるようになり，臨床検査の方法や技術および検査所見の読み方も一段と飛躍してきた．

　It is our purpose to make a qualitative macroscopic diagnosis of resected primary lesions in the jejunum and ileum.

　For it, we tried to detect macroscopic and microscopic characteristics of them. Materials is shown in table 1. Relationship between macroscopic type of malignant lymphomas and their depth of invasion, size and histological type is shown in tables 2, 3 and 4. A similar datum on carcinoma is also indicated in table 5.

　Epithelial neoplasms out of polypoid lesions had macroscopically characteristic features enough to make a qualitative diagnosis: They were papillary or gyrus-like tumor surface with brown color in formalinfixed material, and abrupt elevation of tumor tissue from the level of normal mucosa. All of polypoid carcinoma showed circular constriction as well as the characteristics mentioned above.

　Polypoid non-epithelial tumors had an appearance of intramural tumors in general. It was difficult to differentiate accurately each of the intramural tumors on superficial appearance alone.

　Ulcerating tumor of circularly constricting type was differentiated adenocarcinoma associated with characteristics of polypoid epithelial tumor at its periphery.

　Ulcerating tumors of non-constricting type consisted of malignant lymphoma, poorly differentiated medullary adenocarcinoma and leiomyosarcoma. The three kinds of tumors were different in form, size and depth of ulcer, and effects on the normal mucosa surrounding the ulcer.

　Diffusely infiltrating tumor with elastic soft consistency and associated neither luminal obstruction nor intestinal shrinkage was definitely malignant lymphoma, whereas the tumor with hard consistency and intestinal shrinkage seems to be metastatic carcinoma.

　As a result, we can make a fairly accurate qualitative macroscopic diagnosis on superficial appearances of each tumors of the jejunum and ileum, adding cut-surface appearances. We hope that these data will become valuable to make a qualitative diagnosis on x-ray and endoscopic examination in the near future.