4) 大腸 (1)病理組織像との対比―ピオクタニン染色による拡大内視鏡像と病理組織像との対比― "VI高度不整" を正しく診断するために

Correlation Between Magnifying Chromocolonoscopic Findings and Histologic Construction of Invasive Colorectal Cancer

要旨　ピオクタニン染色による拡大内視鏡所見には“pitの所見”と“pit以外の所見”の2つがあり，それぞれが組織所見を反映し，癌の診断に大きな役割を果たしている．すなわち，前者は腺管の異型度を反映し，後者は腺管周囲の間質の状況を反映している．“pitの所見”としてはpit形態の複雑さが対応腺管の異型度の指標となり，複雑な形態のpitほど対応腺管の異型度は高くなる．しかし，pit形態だけではSM massive癌の十分な診断指標にはなりえない．工藤班におけるV_I高度不整の定義の中には“pitの所見”とともに，“pit以外の所見”として“pitの輪郭不明瞭”，“stromal areaの染色性低下・消失”の2つの所見があり，これらの所見は癌浸潤に連動する組織浅層の間質変化を反映することで，SM浸潤度を反映し，SM massive癌の総合的な診断に寄与すると考えられた．

　There are two chromocolonoscopic findings using crystal violet staining. One is findings of pits, and the other is findings of its surrounding area, SA. These findings play an important role in detecting invasive colorectal cancers.

　Close correlation was found between complexities of the shapes of pits and atypia of superficial glands in the equivalent area. The more complicated the shapes of pits become, the higher the grade of atypia of the equivalent glands becomes. However, little co-relation was found between the shapes of pits and the histologic construction.

　Staining patterns of SA, SA pattern, was classified into three types, stained, fading, unstained. These patterns, correlate with not only histologic depth of cancer invasion but also histologic changes of the components including mucosal layer, muscularis mucosae and desmoplasia.