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Stomach and Intestine(Tokyo) Volume 19, Issue 12 （December 1984）

胃と腸 19巻12号（1984年12月発行）

Japanese English

研究

大腸上皮性腫瘍生検組織の異型度の客観化 Objective Standardization of Grade of Struc-tural and Cellular Atypicalities in Epithelial Tumors of the Large Intestine: The Morphometric Analysis of Biopsy Material 渋谷進 ¹ , 中村恭一 ¹ , 池園洋 ¹ , 東郷實元 ¹ , 菊池正教 ¹ S. Shibuya ¹ , K. Nakamura ¹ , H. Ikezono ¹ , S. Togo ¹ , M. Kikuchi ¹ ¹筑波大学基礎医学系病理 ¹Department of Pathology, Institute of Basic Medical Sciences, the University of Tsukuba, School of Medicine pp.1341-1348

発行日 1984年12月25日 Published Date 1984/12/25

DOI https://doi.org/10.11477/mf.1403109525

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要旨　生検組織にみられる大腸上皮性腫瘍の異型度を客観的に表現するため，構造異型と細胞異型の形態計測を行い，その客観的数値と病変の異型度とを比較検討した．対象は大腸良性腺腫190病変，良性悪性境界領域46病変，癌59病変である．それら病変の組織標本を画像診断処理装置を用い，乱れ係数（一定倍率の顕微鏡像における腺管面積と間質面積の比），重複ドーナツ係数（一定倍率の顕微鏡像におけるマイナスオイラー標数腺管出現率），核腺管係数（一定倍率の顕微鏡像における核腺管面積比）を測定し，前2項を構造異型の尺度，最後の項を細胞異型の尺度とした．その結果，乱れ係数は良性腺腫2.34±0.82，良性悪性境界領域病変3.84±1.04，癌4.34±1.24で，重複ドーナツ係数は良性腺腫7.2±7.2，良性悪性境界領域病変12.6±9.6，癌42.6±31.4で，核腺管係数は良性腺腫0.37±0.07，良性悪性境界領域病変0.46±0.06，癌0.57±0.06であり，3係数とも重なり合いを示しながらも差がみられ，t検定にて有意差が認められた．以上のごとく，病変の異型度の順（良性―境界―癌）に3係数の数値は並び，客観的指標として適切であるとみなされた．更に，3係数を用い，良性悪性境界領域病変の振り分け診断を試み，16病変が良性とされ，7病変が癌と診断されたが，残りの23病変は依然として，良性悪性境界領域病変として残った．

　The purpose of this paper is to standardize objectively structural and cellular atypias of adenoma and carcinoma of the large intestine.

　Biopsy specimens taken from 324 cases of polyps and carcinomas of the large intestine were histologically classified into three groups, definitely benign adenoma and definite carcinoma situated at the mucosa, and adenoma with severe atypia except the former two. Number of them consists respectively of 190, 59, and 46 cases in that order (Table 1).

　1) The two dimensional analysis of structural atypia (Table 2) : the average of the Index of Structural Atypia (ISA＝area of glands per unit area/ area of stroma per unit area) was as follows ; benign adenoma 2.34±0.82, borderline lesion 3.84±1.04, carcinoma 4.34±1.24 (Fig. 2, Table 3). ISA of benign adenomas and borderline lesions showed a normal distribution. Application of “t” test shows a p of less than 0.05 for the difference in the mean value of the indices among them.

　2) The structural atypia of three dimensions could be expressed topologically as minus Eular's characteristics (-K) in a plane (Table 2). The average of Index of Double Doughnuts (IDD = number of -K glands per unit area/number of glands per unit area×100) was as follows ; benign adenoma 7.2±7.2, borderline lesion 12.6±9.6, carcinoma 42.6±31.4 (Table 4, Fig. 3). Application of “t” test shows a p of less than 0.01 for the difference in the mean value of the indices among them.

　3) The average of Index of Nucleus-Gland ratio (Fig. 1) (ING = area of nucleus per gland/area of cells per gland) was as follows ; benign adenoma 0.37±0.06, borderline lesion 0.46±0.06, carcinoma 0.57±0.06 (Table 5, Fig. 4). ING of benign adenomas and borderline lesions showed a normal distribution. Application of “t” test shows a p of less than 0.01 for the difference in the mean value of the indices among them.

　4) Forty-six borderline lesions were divided into carcinomas and benign adenomas by using ISA, ING (more than mean＋2SD) and IDD's values (3.69×mean) of benign adenoma. The obtained results were as follows ; sixteen were benign, seven were malignant, but the remaining 23 lesions (50%) could not be determined, that is, so-called “borderline” from the view-point of both cellular and structural atypia (Fig. 5).