胃粘膜下腫瘍の病理鑑別診断の進歩―特に免疫組織化学的手法による鑑別診断

Recent Development in Histopathology of Submucosal Tumor of the Stomach: Especially Immunohistochemical Diagnosis

要旨　粘膜下腫瘍の中では非上皮性腫瘍が多く，組織学的には紡錘形細胞の形態をとり病理組織診断上，鑑別が困難であることがある．近年，免疫組織化学的染色法が開発され，細胞の細胞骨格や産物組成の中の物質を特定することができるようになった．この方法は，特定の物質を抗原として抗体を作り，この抗体にペルオキシダーゼを結合させたもので，抗原抗体反応により微量定性的な手法で染め出すものである．その方法はperoxidase anti-peroxidase complex（PAP）法であるが，また二次抗体以後の反応にレクチンを用いたアビチン・ビオチンcomplex（ABC）法などが考案され，これは感度も高く，著しく応用範囲が拡がった．現在，消化管の粘膜下腫瘍の鑑別によく利用されている抗体は，vimentin，desmin，S-100蛋白，neuron-specific enolase（NSE）などの抗体である．これらの抗体を用いた免疫組織化学的染色性は筋原性か神経原性腫瘍かの鑑別に有用であることを述べた．

　Submucosal tumors mainly consist of non-epithelial tumors most of which are spindle-cell tumor and are difficult in differential diagnosis each other. Recent advances in immunohistochemistry made it possible to identify and demonstrate the presence of various material in tumor cells such as filaments of cytoskeleton and products of cells.

　The immunohistochemical staining based on antigen antibody reaction in which a certain enzyme (usually peroxidase) bounded to antibody will play a roll in producing a color through its biochemical reaction with substrate. There are two popular immunohistochemical procedures: one of them is peroxidase-antiperoxidase complex (PAP) method, and the other is avitin-biotin complex (ABC) method. The latter contains lection (avitin-biotin) reaction in the procedures and is said to be more sensitive than PAP method.

　The antibodies commonly used for differential diagnosis of submucosal tumor in the stomach are those for vimentin, desmine, myosin, S-100 protein, neuronspecific enolase and so on.

　In the present paper, we described clinicopathological and immunohistochemical findings of various submucosal tumors in the stomach.