胃粘膜におけるPhosphorylase反応とその診断的意義の検討

ON PHOSPHORYLASE REACTION IN THE GASTRIC MUCOSA AND ITS DIAGNOSTIC SIGNIFICANCE

Ⅰ．はじめに

　胃粘膜の組織酵素化学的研究に関する文献は少ないものではない．それは胃の器質的ないし機能的病変の本質を追求する1つの手段として応用され，さらにはまた，臨床診断への応用を目的とした立場からの努力もなされている．しかし，特に後者の立揚には，組織化学的方法が臨床診断に応用し得るかどうかという唯一つの目的のためのみに追求されるきらいがあり，その酵素の正常細胞ないし癌細胞における代謝上の意義ないし特性についての考察が等閑にされがちであるように思われる．したがって，代謝機構における癌特異性の酵素が明らかにされていない現状で，むやみに酵素化学的方法を応用したとしても，少なからぬ例外に遭遇した場合の意義づけに困却し，その後の研究の進展が停滞されるのではないかと考えられる．

　このような意味では，武内^{9)～12)14)16)}がその代謝特性について充分な基礎的研究を行ない，腫瘍細胞における意義づけを行なっているPhosphorylase反応（以下Phr．反応と略す）を，臨床的見地から応用することは理論的解析が可能な点で意義があり，その成績については，既にたびたび報告してきたが²⁾，ここではその総括的成績にっいて胃粘膜のPhosphorylase反応を検討して述べる．

　Phosphorylase reaction in the gastric mucosa, although sometimes positive in a part of the surface epithelia, is almost always negative or at most only slightly positive in the proper cells of the gastric glands. This reaction. on the other hand, is almost invariably positive in tissues of gastric cancer when the specimen is as yet fresh. The positive reaction in cases other than cancer has been observed in the cytoplasm around the nucleus, distributed in a regular and stationary way. In cancer tissues, on the contrary, the positive degree of the reaction is very much varied in each of tubules and cells of gastric cancer, and the mode of its appearance in not restricted to the margins of the nucleus, but may be found everywhere within the cytoplasm, characterized by the irregularity and disorderliness in the way of its appearance. Irregular manifestation of this reaction in gastric cancer cells is due to the difference in the phase of their mitosis; in normal cells the reaction takes place uniformly because of rare occurrence of mitosis. Study of 180 sections, based on these observations, to correlate their atypicality with the mode of phosphorylase reaction has shown that it is positive in distinctly non-cancerous tissues. However, these positive areas are strictly confinecl only in surface epithelia as well as in gastric epithelia that have undergone metaplastic change into intestinal ones. On no account can they ever be mistaken for areas of cancer. Cancerous parts have shown in all cases positive result. It is of interest to note that although some of atypical epithelia have shown positive reaction, their cancerous transformation can be presumed from its way of manifestation within the cytoplasm. In other words, in case of cancerous change and mitosis, the mode of appearance of positive reaction becomes disorderly. Even when it is intense in epithelia in which no cancerous change has as yet taken place, it is impossible to demonstrate any difference in the degree of reaction in each of their cells or the irregularity in the way of its manifestation.