胃癌の進展に伴う組織像の変化―剖検例，切除胃の検索から

The Relation Between the Histological Types of Gastric Carcinoma and the Mode of Spreading: The morphological change of the carcinoma by infiltration

　筆者は先に胃癌の組織型を，①“腺管の分化度”という純形態学的指標に加え，②“粘液の産生”という癌細胞の機能面での特徴の1つを指標とし，両者の組み合わせにより，（Ⅰ）腺管形成良，胞体内粘液量少―tubular differentiation：well，mucus in cytoplasm：poor（以下Ⅰ群），（Ⅱ）腺管形成良，胞体内粘液量多―tubular differentiation：well，mucus in cytoplasm：rich（以下Ⅱ群），（Ⅲ）腺管形成不良，胞体内粘液量少―tubular differentiation：poor，mucus in cytoplasm：poor（以下Ⅲ群），（Ⅳ）腺管形成不良，胞体内粘液量多―tubular differentiation：poor，mucus in cytoplasm：rich（以下Ⅳ群）の4型に分類して（Fig. 1），剖検例を対象に胃癌の組織型別にみた進展様式の特徴を検討し報告したが¹⁾，今回は漿膜下層以上に浸潤増殖した進行胃癌切除標本を対象に加え，癌の浸潤に伴う形態学的変化について検索し興味ある所見を得たので報告する．

　I categorized four histological types of gastric carcinoma by combination of each two indices, namely, (1) the degree of differentiation of glandular tubules, well and poor, and (2) the amount of intracellular mucus, rich and poor, and the following conclusions were obtained by detailed pathohistological study in autopsy cases died by gastric carcinoma and the resected materials of gastric carcinoma. (A) In the cases in which predominant histological type in the lamina propria was “tubular differentiation: well, mucus in cytoplasm: poor”, compared to the other cases, the other three groups, “tubular differentiation: well, mucus in cytoplasm: rich”, “tubular differentiation: poor, mucus in cytoplasm: poor”, and “tubular differentiation: poor”, mucus in cytoplasm: rich, were predominant, there was a greater incidence of coexistence of the histological types of other groups in the lamina propria, while in the subserosa, histological image of “tubular differentiation: poor” was predominant, which may be considered to be followed by the direct invasion into the surrounding organs. (B) In all the cases in which the predominant histological type in the lamina propria was “tubular differentiation: poor”, the predominant histological type in the subserosa was also “tubular differentiation: poor”. (C) When studying the development and metastasis of gastric carcinoma, not only should one consider from the predominant histological types alone, but one must also consider the characteristics of the each coexisting histological type carcinoma, especially in cases classified “tubular differentiation: well, mucus in cytoplasm: poor”.