胃底腺粘膜の萎縮度からみた腺領域の病理組織学的検討

A Histopathological Study of the Gastric Glandular Area from the Viewpoint of Atrophic Degree of Fundic Gland Mucosa

要旨　胃の腺領域については多くの研究があるが，臨床病理学的には中村の分類が広く用いられている。けれども，腸上皮化生の有無で決定する定義に従うと，腸上皮化生のない萎縮した胃底腺の境界に悩むことも少なくない．胃底腺の萎縮度を胃底腺が1ないし数腺管単位で散在性に認められる領域，胃底腺が巣状に認められる領域，萎縮した胃底腺が連続して認められる領域，胃底腺は正常腺管であるがリンパ球浸潤がみられ腺管間がわずかに開大した領域，胃底腺が全く萎縮のない領域の5段階に分け，腺境界について33例の切除例を用いて検討した．境界線の拡がり方，F境界線との比較，肉眼所見，小さな癌の背景粘膜，胃底腺領域に発生した分化型癌などについて検討した結果，胃底腺領域を萎縮した領域，萎縮のない領域，その境界領域と分類することが臨床病理学的には整合性が高いと言えた．腸上皮化生の程度は胃底腺粘膜の萎縮度と相関があるものの，萎縮度で判定したほうがより的確に境界づけられ，中村の境界線との比較では，上記3領域を分ける境界線を新たにF境界線，f境界線とするほうが適当と考えられた．また，境界領域は移行帯あるいは萎縮移行帯と称するのがよいと考えられた．肉眼所見での対比では，F境界線は粘膜ひだで比較的捉えやすく，f境界線は血管透見，胃小区模様で捉えやすい結果であり，後者のほうが組織学的境界線とより適合した．

　The area of gastric glands has been studied clinicopathologically by many researchers. And Nakamura's classification of gastric mucosa defined by intestinal metaplasia in the fundic gland mucosa has been used widely. The progress of intestinal metaplasia was clearly related to the degree of the atrophy of the fundic gland mucosa, but the histopathological figure of the atrophic degree of the fundic gland mucosa was not expressed clearly. To classify the degree of atrophy in five groups, thirty-three cases of gastrectomy specimens were examined histopathologically.

　Studying the fundic gland mucosa through the pattern of boundary lines, the contrast with the Fboundary line, comparison with the macroscopical figures, and the relation of the histopathological figures of small carcinomas, it was decided to divide the gastric gland into three areas. One area was the mucosa with marked atrophy, another was the mucosa without atrophy, and the other was the area between the former two, which was found to be moderately atrophic.

　The intestinal metaplasia and the pseudopyloric gland had some relationship to the atrophy of the fundic gland mucosa, but clinicopathologically, the atrophic figure of the fundic gland mucosa was able to be classified more exactly without reference to intestinal metaplasia or the pseudopyloric gland.

　The areas constituted two boundary lines, the analside boundary line and the oral-side boundary line. The anal-side boundary line was related to the macroscopical figure of the pattern in the gastric area and the capillaries seen in the mucosal area. The oral-side line was related more to the mucosal fold. The average width between these lines was less than 2.0 cm at the middle portion of the body.

　Contrary to Nakamura's definition, it was thought that the oral-side line should be named the F-boundary, and the oral-side line should be called the f-boundary line. And the area between the two boundary areas was named the “shift zone”, regarding to the histopathological figure of gradual atrophy of fundic gland mucosa.