胃底腺粘膜領域の分化型癌の臨床診断

Clinicopathological Study of Gastric Carcinoma in the Fundic Glandular Mucous Membrane Area

要旨　1988年から1993年までに癌研外科で切除され，病理検索が終了した胃癌907例を対象として，背景胃粘膜と癌組織型の関係について検討した．幽門腺粘膜領域（噴門腺粘膜領域を含む）では分化型癌50％（313/624例）と未分化型癌50％（311/624例）はほぼ等しく，中間領域では分化型癌32％（58/180例），未分化型癌68％（122/180例）で未分化型癌が多く，胃底腺粘膜領域では分化型癌2％（2/103例），未分化型癌98％（101/103例）とほとんどが未分化型癌であった．胃底腺粘膜領域に存在した分化型癌の2例は，肉眼型はいずれもⅡc＋Ⅲ型とⅡa＋Ⅱc型，深達度はⅡc＋Ⅲ型がmp癌，Ⅱa＋Ⅱc型がsm癌，リンパ節転移はいずれも陰性であった．胃底腺粘膜領域に存在した分化型癌の2例について粘液組織学的染色を行ったところ，いずれも腸型の発現形質を示したことから，2例は胃底腺粘膜内の局所的な腸上皮化生巣からの発生が推定された．

　We studied the relationship between background gastric mucous membrane and histologic types of carcinoma in 907 patients having gastric carcinomas excised in the Department of Surgery (Cancer Institute Hospital) and pathologically examined between 1988 and 1993. In the pyloric glandular mucous membrane area (including the cardiac glandular mucous membrane area), well-differentiated carcinomas were found in 50% of the cases (313/624) while undifferentiated carcinoma were found, at an equal rate, in 50% of the cases (311/624). In the intermediate mucous membrane area, well-differentiated carcinomas were found in 32% of the cases (58/180) while undifferentiated carcinomas were found in 68% of the cases (122/180). In the gastric fundic glandular mucous membrane area, well differentiated carcinomas were found in 2% of the cases (2/103) while undifferentiated carcinomas were found in 98% of the cases (101/103), showing that most carcinomas were undifferentiated. Macroscopically, the two cases of well-differentiated carcinomas in the gastric fundic glandular mucous membrane area were the depressed type. In one case the cancer had invaded the muscular propria (mp), and, in the other case, the cancer was limited to the submucosal layer (sm). In neither case was there metastasis to the lymph nodes. In these well-differentiated carcinomas in the gastric fundic glandular mucous membrane area, the mucous was histochemically stained and the carcinomas in each case possessed the form and properties of intestinal types. Therefore, it was suspected that the carcinomas had generated from a local intestinal metaplasia lesion in the gastric fundic glandular mucous membrane.