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Stomach and Intestine(Tokyo) Volume 25, Issue 8 （August 1990）

胃と腸 25巻8号（1990年8月発行）

Japanese English

今月の主題臨床経過からみた胃生検の問題点

主題

胃隆起性病変における生検診断GroupⅢの問題点―内視鏡的立場より Gastric Protruded Lesions Diagnosed As GroupⅢ by Biopsy: Diagnostic Problems from the Endoscopical Point of View 早川和雄 ¹ , 福地創太郎 ¹ , 木村孝 ¹ , 橋本光代 ¹ , 吉田行哉 ¹ , 星原芳雄 ¹ , 小松淳 ² , 惣名司 ² , 海上雅光 ³ Kazuo Hayakawa ¹ ¹虎の門病院消化器科 ²虎の門病院内視鏡室 ³虎の門病院病理学科 ¹Department of Gastroenterology, Toranomon Hospital キーワード： GroupⅢ , Ⅱa-subtype , 異型上皮巣 , 生検診断 , 内視鏡的胃粘膜切除 Keyword: GroupⅢ , Ⅱa-subtype , 異型上皮巣 , 生検診断 , 内視鏡的胃粘膜切除 pp.927-939

発行日 1990年8月25日 Published Date 1990/8/25

DOI https://doi.org/10.11477/mf.1403111327

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要旨　初回生検でGroupⅢと診断された隆起性病変224病変のうち，手術あるいは内視鏡的切除術を行い，最終組織診断が得られた53病変について，内視鏡所見と組織所見を対比し，生検診断GroupⅢの問題点を検討した．53病変中36病変（67.9％）は組織学的にⅡa-subtypeを含む異型上皮巣であり，17病変（32.1％）が癌であった．癌はすべて高度に分化した癌であり，初回生検で癌と診断しえなかった理由は，生検という小さな組織片による限られた情報に起因していたと考えられる．内視鏡診断をみるとⅡa-subtypeを含む異型上皮巣では，多くはⅡa-subtypeないしはその疑いと診断していた．一方，癌では約30％がⅡa-subtypeとの鑑別が極めて困難であったが，65％はⅡa-subtypeと多少とも異なる内視鏡所見を示し，内視鏡的に癌が疑わしい例であった．生検でGroupⅢと診断された場合，内視鏡所見および生検所見より，総合的にⅡa-subtypeと判定した場合は経過観察でよいが，内視鏡的に癌が疑わしい場合は，病理医との緊密な連携のうえで速やかに再生検を行い，それでも結論の出ない場合には，内視鏡的切除術の対象となると考える．

　We discussed here about the problems associated with gastric protruded lesions histologically diagnosed as GroupⅢ by biopsy. Comparison was made between endoscopic and histologic findings of 53 lesions in which definitive histological diagnosis was made on surgical specimens or endoscopically resected materials obtained from 224 protruded lesions initially diagnosed as GroupⅢ by biopsy. Of those 53 lesions 36 lesions (67.9%) were histologically diagnosed as atypical epithe-lium including Ⅱa-subtype, while the remaining 17 (32.1%) were carcinoma. Carcinoma was of well differentiated type in all these 17 lesions. It was speculated that initial biopsy specimens were not large enough for detecting carcinoma. Most of the lesions of atypical epithelium including Ⅱa-subtype were endoscopically diagnosed or suspected as Ⅱa-subtype, while 30% of carcinoma lesions were difficult to endoscopically differentiate from Ⅱa-subtype lesions and the remaining 65% exhibited f findings somewhat different from Ⅱa-subtype and were justifiably suspected as carcinoma.

　Thus, faced with the lesion diagnosed as GroupⅢ by biopsy, it would be recommended that the patient be followed-up in case of Ⅱa-subtype considered either endoscopically or histologically, and that biopsy be repeated in case of endoscopically suspected carcinoma. When the repeated biopsy fails to lead the definitive diagnosis, endoscopic resection should be performed.