肺腺癌の発育進展に関する臨床病理学的検討  [in Japanese] Clinicopathological Study of the Development of Adenocarcinoma of the Lung  [in Japanese]

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Abstract

目的.肺胞上皮置換型増殖を示す肺腺癌の発育形式を明らかにするために臨床病理学的検討を行った.対象・方法.1986年から2000年までに切除した最大径30mm以下の原発性肺腺癌のうち肺胞上皮置換型増殖を示す221例を対象とした.腺癌内部の所見について四つに分類した.(1)Typical hronchioloalveolar carcinoma(BAG):肺胞上皮置換型増殖のみのもの,(2)Alveolar sental fibrosis(AF)type:肺胞隔壁に薄い膠原線維を伴うもの,(3)Destruction of alveolar framework(DA)type:肺胞骨格網の破壊を伴うもの,(4)Destruction with collagen fibrosis(DC)type:肺胞骨格網の破壊に膠原線維性線維化巣を伴うもの.結果.各組織型の平均腫瘍径はTypical BAC(n=26)が12.7mm,Aftype(n=38)が16.3mm,Datype(n=21)が18.8mm,Dctype(n=136)が21.9mmであった.5年生存率はTypical BAC,Aftype,Datypeが100%,Dctypeが66.1%であった.結論.肺胞骨格網の破壊は浸潤像であるが,膠原綿維性線維化巣を伴わなければ予後は良好であった.肺胞上皮置換型増殖を示す肺腺癌は,Typical BAGからAftype,Datype,そしてDctypeへと進む腫瘍群であり,Dctypeが進行浸潤癌と呼ぶべき病態であると考えられた.

Objective. To clarify the development procedures of lung adenocarcinomas showing lepidic growth pattern. Material and Methods. We assessed 221 consecutive surgically resected cases of lung adenocarcinoma less than 30 mm in diameter and histologically diagnosed as bronchioloalveolar carcinoma (BAG) or as adenocarcinoma consisting of mixed BAG and other components between 1986 and 2000. Four patterns were recognized from the viewpoint of the relationship between the alveolar wall and tumor cells: (1) only lepidic growth pattern (typical BAG), (2) adenocarcinoma with alveolar septal thin collagen fibrosis (AF type), (3) adenocarcinoma with destruction of alveolar elastic fiber framework (DA type), (4) adenocarcinoma with destruction with heavy collagen fibrotic foci (DC type). Results. The mean tumor diameter according to the histological subtype was 12.7 mm for typical BAG (n = 26), 16.3 mm for the AF type (n = 38), 18.8 mm for the DA type (n = 21), and 21.9 mm for the DC type (n = 136), respectively. The 5-year survival rates for patients with typical BAG, AF type and DA type were all 100%, but that for the DC type was 66.1%. Conelusion. Destruction of alveolar framework was indicated by findings of stromal invasion, but the prognosis was good if not accompanied with foci of collagen fibrosis. We speculate that lung adenocarcinoma showing a lepidic growth pattern grows to the AF type and then the DA type from typical BAG and thereafter to DC type more. The DC type should be called advanced cancer.

Journal

  • Japanese Journal of Lung Cancer

    Japanese Journal of Lung Cancer 44(2), 95-101, 2004-04-20

    The Japan Lung Cancer Society

References:  12

Cited by:  1

Codes

  • NII Article ID (NAID)
    110003140644
  • NII NACSIS-CAT ID (NCID)
    AN00203978
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    03869628
  • Data Source
    CJP  CJPref  NII-ELS 
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