内視鏡医が知っておくべき・病理医が内視鏡医に伝えておきたい胃病理診断

Pathology of the stomach that endoscopists should understand

要旨

胃内視鏡診断を行う内視鏡医にとって知っておくべき病理学的事項を整理する。胃の正常組織像をよく理解し，びらん・萎縮・化生・腫瘍といった，頻繁に遭遇する所見の組織像を知ることで，内視鏡所見の成り立ちに対する理解はより深まる。病理診断には基本的なHE染色以外にも，特殊染色や免疫組織化学染色が用いられることがあるが，それらの種類や目的，注意点についても知っておくとよい。また実際に病理診断を依頼する際に病理医に伝えるべき情報は何か，逆に病理診断報告書を受け取った際に注意すべき点は何か，といった実用的側面についても理解を深めておくことが望ましく，日常診療におけるカンファレンスなどを通し，内視鏡医・病理医の信頼関係を構築することは，適切な診療のためにはきわめて重要である。病理診断は病理医により行われる専門性の高い医行為であり，病理診断結果は診療にとって重要なだけでなく，高い学術的価値を有する。学会や論文発表における病理所見や病理画像の提示の際には病理医の貢献を考慮した，適切なオーサーシップを検討すべきと考えられる。

　In this article, the author emphasizes the importance of pathological knowledge for endoscopists conducting gastroscopic diagnoses. Key to this understanding is the histology of the normal gastric mucosa and the identification of common abnormalities such as erosion, atrophy, metaplasia, and neoplasia, including tumors. Beyond basic Hematoxylin and Eosin (H&E) staining, the use of special and immunohistochemical staining techniques in pathological diagnosis is highlighted. The article stresses the importance of familiarity with the types, purposes, and problems of these staining methods. The author also underscores the significance of practical aspects in pathology. This includes the crucial information endoscopists need to provide to pathologists when requesting a pathological diagnosis and the key points to consider when interpreting pathological diagnostic reports. The establishment of a trust-based relationship between endoscopists and pathologists, facilitated through regular conferences and interactions in clinical practice, is presented as vital for ensuring appropriate patient care. Furthermore, the article acknowledges the specialized nature of pathological diagnoses performed by pathologists and their critical role not only in clinical practice but also in academic research. The author advocates for recognizing pathologists' contributions, suggesting that proper authorship should be considered when presenting pathological findings and images at academic conferences and research papers, reflecting the pathologists' integral role.