胃と腸42巻6号

2007年05月発行

今月の主題 Helicobacter pyloriと胃癌

主題

Helicobacter pylori陽性胃癌と陰性胃癌の比較―病理の立場から：H. pylori陰性・非萎縮性粘膜に通常型胃癌は発生するのか

著者： 九嶋亮治¹ 松原亜季子¹ 柿木里枝¹ 竹村しづき² 馬場正道³ 石田光明⁴ 岡部英俊⁴ 斉藤康晴⁵ 服部隆則²

所属機関： ¹滋賀医科大学附属病院病理部 ²滋賀医科大学病理学講座 ³済生会滋賀県病院病理科 ⁴滋賀医科大学附属病院検査部 ⁵滋賀医科大学附属病院光学医療診療部

ページ範囲：P.967 - P.980

文献概要

要旨　Updated Sydney systemに準じ，担癌胃粘膜が総合的に慢性炎症（0または1＋），活動性（0），萎縮（0），腸上皮化生（0または1＋），HP（0）であるものを"HP陰性・非萎縮性胃粘膜"発生癌と定義し，それ以外の"HP陽性・萎縮性胃粘膜"発生癌との比較検討から，通常型胃癌の特性と組織発生の再評価を試みた．ESDで得られた分化型腺癌87例のうち，"HP陰性・非萎縮性胃粘膜"発生と考えられたのはわずか1例（1.1％）であった．外科手術標本では445例中15例（3.4％）が該当した．ESD症例で"HP陽性・萎縮性胃粘膜"発生分化型腺癌の背景粘膜における，慢性炎症，萎縮，腸上皮化生の各項目の平均値はいずれも1.6ポイント前後であり，分化型腺癌は"慢性炎症性で萎縮しつつある粘膜"に発生するものが多いことが示唆された．上記に加え，これまで収集した"HP陰性・非萎縮性胃粘膜"発生癌は，分化型腺癌7例（41～82歳，平均67.0歳），未分化型癌14例（41～82歳，平均62.5歳）で，胃底腺粘膜に発生し胃型形質を発現するものが多い傾向がみられた．しかし，腸上皮化生のほとんどない"HP陰性・非萎縮性胃粘膜"に発生する癌においても"癌の腸型化"が確実に生じており，特に未分化型癌では癌細胞の腸型化は癌の進展に伴う変化であることが再認識された．このことはホメオボックス遺伝子CDX2由来蛋白の発現をみることでより明らかになった．

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