表面型大腸腫ようの肉眼形態と細胞動態に関する研究  [in Japanese] Macroscopic classification and kinetic alternations in the superficial lesion of colorectal neoplasms.  [in Japanese]

Access this Article

Author(s)

    • 渡 二郎 WATARI Jiro
    • 旭川医科大学第3内科|旭川厚生病院消化器科 Third Department of Internal Medicine, Asahikawa Medical College|Department of Gastroenterology, Asahikawa Kosei General Hospital

Abstract

表面型大腸腫瘍の肉眼形態の違いと腫瘍の発育様式との関係を知るため,表面隆起型42病変といわゆる表面陥凹型42病変を用いて,腫瘍細胞の粘膜内全層性発育率(全層率)およびKi-67染色による増殖細胞の分布を検討した.表面陥凹型は辺縁隆起の性状と中心陥凹の程度によりDep(A)型,Dep(B)型,Dep(C)型に分けた.全層率は,腺腫では辺縁隆起が目立たなくなるに従い,中心陥凹が広く明瞭になるに従い,すなわち表面隆起型<Dep(A)型<Dep(C)型の順に増加した(<I>p</I><0.05)が,癌ではどの肉眼型でも高かった.Ki-67陽性率は,組織異型度が高くなるに従い増加したが,高度異型腺腫と癌の間には差がなかった.Ki-67陽性細胞の分布は,腺腫,癌ともに表面隆起型とDep(A)型では粘膜表層部により多いのに対して(<I>p</I><0.05,<I>p</I><0.01),Dep(C)型では粘膜全層に広く分布し,かつ,growth fractionも拡大していた.したがって,Dep(C)型は表面隆起型とDep(A)型に比べて全層率が高いこと,および増殖細胞動態の関係から,粘膜下浸潤を来す機会が多いものと考えられる.

To clarify relation between macroscopic appearance and the mode of tumor growth in the superficial lesion of colorectal neoplasms, we compared their colonoscopic findings with histological architecture of tumor cells. Macroscopic type was classified into the superficial elevated lesion (IIa, <I>n</I>=42, mean 5.14mm) and the superficial depressed lesion (<I>n</I>=42, mean 3.84mm). The latter was further divided into 3 subtypes ; subtype A, an irregular depression with high marginal elevation (Dep (A), <I>n</I>=20) ; subtype B, an irregular depression with irregular marginal elevation (Dep (B), <I>n</I>=7) ; subtype C, a clear and wide depression without marginal elevation (Dep (C), <I>n</I>=15). Histological architecture was evaluated by the transmucosal growth index (TGI) of tumor cells, which is a ratio of tumor width contacting with the muscularis mucosae against that of tumor surface, and by the distribution of proliferating cells detected by Ki-67 antibody (MIB-1).<BR> In adenomas TGI increased with a degree of central depression (IIa<Dep(A)<Dep(C)). In carcinomas TGI was high irrespective of their macroscopic forms. Ki-67 labeling indices tended to increase with histological atypia. Adenomas with severe atypia showed a high labeling consistent with carcinomas. In both adenomas and carcinomas, Ki-67 positive cells were mainly noted in upper third of neoplastic glands in IIa, Dep (A) and Dep (B) neoplasms. By contrast, Dep (C) neoplasms lost a preferential distribution of proliferating cells, which reached the whole neoplastic glands.<BR> These results suggest that Dep (C) adenomas and carcinomas have a unique histopathological architecture in terms of a high TGI and an enlarged distribution of proliferating cells, implying a high malignant potential.

Journal

  • Nippon Shokakibyo Gakkai Zasshi

    Nippon Shokakibyo Gakkai Zasshi 91(11), 2040-2048, 1994

    The Japanese Society of Gastroenterology

Codes

Page Top