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Some Considerations on the Lesion of the Stomach which Appeared Histologically on the Borderline between Benignancy and Malignancy H. Taniguchi 1 , A. Wada 1 , R. Tateishi 1 , T. Iwanaga 2 1Department of Pathology, The Center for Adult Diseases 2Department of Surgery, The Center for Adult Diseases pp.1449-1454
Published Date 1975/11/25
DOI https://doi.org/10.11477/mf.1403112170
  • Abstract
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 An attempt was made to clarify the character of borderline lesion between gastric cancer and benign gastric changes, by the careful histological re-examination on 39 lesions which had been diagnosed as borderline lesion by postoperative histological check of the resected materials. Their gross findings were all similar to Ⅱa type of early gastric cancer. Histological criteria of the borderline lesion were made as localized proliferation of atypical cells which closely resembled intestinal metaplasia but with more dominant cellularity, dense ordination of hyperchromatic nuclei, irregularity of glandular pattern, etc. The atypical structure was generally confined in the superficial half level of the elevated mucosa, and the deeper tissue showed non-atypical metaplasia and normal pyloric or fundic glands. The obtained results were summarized as follows:

 1. Atypical gland of the borderline lesion was sharply demarcated by normal mucosal tissue. That is, atypical epitheria collided with non-atypical ones in the same glandular space without the transitional zone, though characters of intestinal metaplasia were common in both tissue. These findings were supportive for neoplastic character of the borderline lesion.

 2. Mitotic cell distributions were compared among the borderline lesion, Ⅱa type of well-differentiated adenocarcinoma, ordinary intestinal metaplasia in the stomach and adenoma of the large bowel. Mitotic figures were observed much frequently at the deeper level in the ordinary intestinal metaplasia, while mitosis was located predominantly at the superficial level in the others.

 3. Paneth's cells were also observed in some of the borderline lesions, but the distribution was more irregular than in ordinary intestinal metaplastic gland, in which Paneth's cells were confined to the bottom. The disordered localization of Paneth's cells may suggest that the borderline lesion has neoplastic character because it must be a result of dispolarity due to autonomic proliferation.

 From the above three information, the borderline lesion was more reasonably understood as adenomatous rather than reactive hyperplasia. It is, however, difficult to rule out the possibility of carcinoma or reactive hyperplasia because a certain borderline lesion might be diagnosed only because of its adenoma-like appearance. Therefore it is concluded that the borderline lesion is prolifarative disorder mainly belonging to benign adenoma. Most of them are benign clinically, but careful follow-up must be done for a long term.


Copyright © 1975, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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