肝内小結節病変の針生検組織診と細胞診 特に高分化型肝細胞癌の細胞像を中心に:特に高分化型肝細胞癌の細胞像を中心に [in Japanese] Usefulness of cytodiagnosis in fine needle biopsy of intrahepatic small tumors. [in Japanese]
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肝内小結節性病変の針生検時に得られた細胞診と組織診を対比して, 肝生検における細胞診の有用性を証明した. 対象とした69結節のうち良性病変は14結節で, 結節性脂肪変性, 肝硬変の再生結節, 腺腫様過形成などがみられ, それぞれの組織に対応した細胞像が認められた. 悪性腫瘍は55結節で, 高分化型肝細胞癌は43結節で細胞診では30結節 (約70%) に正診が得られた. 中分化肝細胞癌, 転移癌では全例に正診が得られた. また壊死や生検組織が微小であるために組織診断の不可能な場合に細胞診のみで悪性という診断をうることのできたのが5例あった.<BR>腫瘍細胞に類似した異型細胞としてlarge cell dysplasiaがあるが, 大型の異型細胞で核の濃染性と核小体の腫大を特徴とするが, 核不整や核縁の肥厚は弱く, N/C比も高くないという点で異なる. 高分化型肝細胞癌の細胞像は (1) 細胞集塊では細胞核密度の増加,(2) 細胞は小型で, 均一な印象,(3) N/C比は増加するがanisokaryosisは弱い,(4) 核の偏在傾向がみられ, 多くは淡明な細胞質を持つ, などの特徴を示す. しかし腺腫様過形成などの境界病変との区別の難しい場合もある. 肝臓の細胞診の正診率の向上には十分な細胞数を得るとともに, 境界病変の細胞像の記載の充実がのぞまれる.
The usefulness of cytodiagnosis in fine needle biopsy of intrahepatic small lesions was demonstrated from comparison of the accuracy of cytodiagnosis with that of histodiagnosis. Fourteen of 69 nodules examined were benign lesions showing focal fatty degeneration, regenerative nodules in liver cirrhosis and adenomatous hyperplasia. Each had its own peculiar cytologic features. Forty-three nodules from 55 malignant tumors were well-differentiated hepatocellular carcinomas, about 70% of which were correctly diagnosed by cytology. All of the moderately differentiated hepatocellular carcinomas and metastatic carcinomas were diagnosed correctly only by cytodiagnosis. While sufficient materials for histodiagnosis were not obtained from 5 nodules, cytodiagnostic materials were sufficient for a correct diagnosis of malignancy.<BR>Atypical cells from large cell dysplasia of the liver were similar to malignant cells. They were large and had dark nuclei with prominent nucleoli, but differed in terms of their nuclear irregularity, minimal thickening of the nuclear rim, and the lack of a markedly elevated nucleo/cytoplasmic ratio.<BR>The important diagnostic features of well differentiated hepatocellular carcinoma were: 1) Increased nuclear density in cell clusters; 2) Small, relatively regular and uniform cells; 3) Increased nucleo/cytoplasmic ratio with weak anisokaryosis; and 4) Peripherally located nuclei, many with a clear cytoplasm. On occasion, however, the differential diagnosis of adenomatous hyperplasia and well differentiated hepatocellular carcinoma was difficult.<BR>To improve the accuracy of cytodiagnosis of liver nodules, sufficient materials are required along with an ample cytological description of the boderline lesions of liver umors.
- The Journal of the Japanese Society of Clinical Cytology
The Journal of the Japanese Society of Clinical Cytology 35(5), 393-400, 1996
The Japanese Society of Clinical Cytology