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Stomach and Intestine(Tokyo) Volume 21, Issue 5 （May 1986）

胃と腸 21巻5号（1986年5月発行）

Japanese English

今月の主題早期胆嚢癌―その診断の進歩

主題

早期胆嚢癌の定義と病理形態学的特徴 Definition and Morphological Characteristics of Early Carcinoma of the Gallbladder 渡辺英伸 ¹ , 鬼島宏 ¹ , 内田克之 ¹ , 近藤公男 ¹ , 岩渕三哉 ¹ Hidenobu Watanabe ¹ , Hiroshi Kijima ¹ , Katsuyuki Uchida ¹ ¹新潟大学医学部第1病理 ¹The First Department of Pathology, Niigata University, School of Medicine pp.483-495

発行日 1986年5月25日 Published Date 1986/5/25

DOI https://doi.org/10.11477/mf.1403110293

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要旨　早期胆囊癌46例（53病変）を用いて，その定義，病理形態学的特徴および肉眼的鑑別診断を検討した．全例にリンパ節転移，脈管侵襲を欠き，4年間に癌再発（死亡）例がなかった．肉眼型では隆起型が26％，表面型が74％で，陥凹型は認められなかった．有茎Ⅰ型は特徴的肉眼像を呈し，腺腫内癌であった．Ⅱb型が40％，肉眼型の複合型が49％を占めた．癌の表面粘膜像は大部分で乳頭状，凹凸のある粗大顆粒状～結節状，半光沢・褐色調であり，Ⅱb型癌5病変では平坦・平滑～微細顆粒状，褐色調であった．仮定した早期胆囊癌の定義“癌の深達度が粘膜内または固有筋層までの癌で，RAS内進展は粘膜内進展とみなす”は妥当であった．癌は肉眼的特徴を有しており，85％で肉眼診断が可能であることより，その特徴は術前診断に有用と考えられた．

　We assessed our definition of early carcinoma of the galldladder in 46 cases (53 lesions) which we diagnosed as early carcinoma, using as our criteria the morphological characteristics and the macroscopic differentiation of the carcinoma.

　After a period of four years during which the subjects had been under observation, there was no recurrence and the subjecs were in good health, In the 46 cases, lymph nodal metastases, lymphatic permeation, venous permeation and neural invasion were negatlVe.

　Macroscopically, the 53 carcinomas were composed of 14 polypoid (protruded) type carcinomas (26%) and 39 superficial type ones (74%). There were no depressed type carcinoma.

　Six of the carcinomas were the pedunculated type, but, histologically, all of the six were carcinomas in adenoma and had macroscopic characteristics as show in Figs. 1 and 2. Among the early carcinomas, 40% were IIb type, and 49% were carcinomas of combined macroscoplc type.

　The surfaces of 44 early carcinomas showed papillary, roughly (varously-sized) granular and nodular patterns, and were not lustrous and brown or yollowish brown in color in the formalin-fixed specimens. Five carcinomas were IIb type ranging from smooth and flat to finely granular in pattern. The other four carcinomas were IIb type microcarcinomas measurlng less than 3.0mm.

　We difiened early carcinoma of the gallbladder as “carcinomas limited to the mucosa or to the mucosa and muscle proper (We regard Rokitansky-Aschoff sinus extension as a mucosal extension).” This definition seems to be correct. The carcinomas had macroscopic characteristics by which 85% of them were able to be diagnosed.