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要旨 大腸pm癌の病理学的特徴を明らかにするために,結腸癌(52病変)と直腸癌(100病変)で,それぞれ,癌巣の固有筋層への深達度が内輪筋層までのpm癌(pm-C癌)と外縦走筋層に達するpm癌(pm-L癌)とに分けて臨床病理学的に分析し,また,わずかに固有筋層を越えて浸潤するSS1(a1)癌と比較検討した.pm癌では,直腸が全症例の2/3を占めて,結腸より腫瘍径・リンパ節転移率が大きく,直腸のpm-L癌が最も悪性度が高かった.しかし,固有筋層を越えることによって急に生物学的悪性度が増すことはなく,特に結腸のSS1癌はpm癌とほぼ同列に扱ってもよいものと思われた.また,pm癌にしばしば認められる潰瘍底の浅い半隆起型病変を,潰瘍型と診断されたものの中から“中間型”として選び,腫瘤型および深い潰瘍型と比較検討した.従来の腫瘤型と潰瘍型の分類では,pm-Cのレベルで既に潰瘍型が過半数を占めたが,“中間型”を設けることによって進行癌の形態変化は深達度と共に緩やかに深い潰瘍型へ移行し,その過程に結腸と直腸とで差があることが示唆された.また,“中間型”と深い潰瘍型のリンパ節転移率は,有意に後者のほうが高かった.
Analyzing 152 operative cases of colorectal pmcarcinomas which were resected during the period of 14years from 1975 to 1988, we investigated pathological features of colorectal pm-carcinoma. We classified the lesions into two groups; pm-C (carcinomas invading the internal circular muscle) and pm-L (carcinomas invading the external longitudinal muscle). The number of the pm-C lesions were 75 (26 in the colon,49 in the rectum), and that of the pm-L lesions were 77 (26 colon, 54 rectum) respectively. The size of the pm-L lesons was in average 5-6mm larger than the pm-C lesons.
Adenomatous component was found in 17.3% of the pm-C and 5.2% of the pm-L with a rather prominent villous variety in the pm-L. Concerning gross type of the tumor, incidence of the ulcerated type was significandy high in pm-L (more than 80% for both colonic and rectal carcinomas). However, when the ulcerated type was divided into“intermediate (Ⅰ)(shallowulcerated) type” or deep-ulcerated (U) type, I type was more frequent in the colonic pm-L (57.7%) than in the rectal pm-L (37.3%), suggesting a slightly different growth pattern of pm-carcinomas between in the colon and in the rectum. Further, the rate of lymph node metastasis was higher in the rectal pm-L (29.4%) than in any other pm-groups. This was probably due to a higher incidence of gross type U in the rectal pm-L. The growth pattern and biological behaviors of colorectal pm-carcinomas may be slightly different between the colon and the rectum.
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