胃癌術後5年経過後の再発―組織像の推移を中心に

Modification of Histologic Pictures in the Patients with Gastric Carcinoma: Study of cases with recurrence more than five years after the surgery

　癌腫の発育状況は例により，また同一例でも時期によって異なり，それは癌腫の組織像によってかなりよく表現される．このことは今井³⁾およびその門下の一連の研究により明確に指摘され，種種の証拠が提示されたが，その中で遠城寺および今井・遠城寺は胃癌を含む種々の臓器癌の同一例における手術時と剖検時の組織像を比較観察し，多くの例において組織像の時期的推移を表わす若干の差異を確認した¹⁾²⁾⁴⁾．しかしこれらの例の大部分では手術より剖検までの期間が短く，したがって手術標本と剖検標本とにおける組織像の差にも著しいものは期待できなかった．

　以後，十数年の間に胃癌の診断，治療は急速な進歩を遂げ，5年生存率の上昇とともに，5年経過後再発する例にもかなり遭遇するようになった．そこで，これらの例の手術時（原発癌）と再発・死亡時（再発癌）との組織標本を同時に検索し，長期間における組織像の推移を検討せんとするものである．なお同じ時期の例で術後短期間で再発死亡し，剖検されたものについても，手術，剖検両標本を観察し，晩期再発例のそれと比較した．

　Gross and microscopic characteristics of the primary carcinoma of the stomach are described in 15 patients with later recurrence more than five years after the surgery. In 6 out of the 15 patients, whole dimension sections of both primary and recurrent tumors were studied microscopically. Sections from 42 patients with recurrence less than five years after the operation were additionally studied for comparison.

　The recurrent tumor, as shown in the autopsy specimen, presented histologic features indicating an exacerbation in the growth of a cancer such as more increased atypicality of cells and nuclei, more sprouting growth of poorly differentiated parenchyma, and more lymphatic- and blood-vessel permeation of malignant cells than the surgically removed primary tumor in the same patient. Marked lymphoid infiltration in the stroma seen at surgery in two patients almost entirely disappeared in the recurrent tumor when autopsied seven years afterwards. The changes in histologic pictures of carcinoma produced in the course of time were more strikingly demonstrated by late recurrence cases than those of early recurrence.