胃と腸44巻4号

2009年04月発行

特集 早期胃癌2009 主題 3．早期胃癌の病理

3）早期胃癌における形質発現分類の基礎的・臨床病理学的意義

著者： 九嶋亮治¹⁴ 松原亜季子¹⁴ 竹村しづき² 馬場正道² 服部隆則³ 下田忠和⁴

所属機関： ¹滋賀医科大学附属病院病理部 ²済生会滋賀県病院病理診断科 ³滋賀医科大学病理学講座 ⁴国立がんセンター中央病院臨床検査部病理

ページ範囲：P.486 - P.498

要旨　胃癌は臨床病理学的な観点から，分化型癌と未分化型癌に分類され，遺伝子経路の違いも報告されてきた．特に前者はHelicobacter pyloriが再発見される以前から，慢性萎縮性胃炎と腸上皮化生を経て発生すると信じられ，intestinal-type carcinomaとも称されてきた．一方，粘液組織化学，さらにMUC遺伝子の発見と免疫組織化学の進展などを踏まえて，胃癌を形質発現の観点から再検討する試みがなされてきた．この流れに沿って，胃型高分化型癌とその対極をなす低異型度完全腸型分化型癌が市民権を得るようになり，体部腺・固有腺型の胃癌の報告もされるようになった．また，形質発現の研究によって，腺腫と良悪性境界病変，印環細胞癌の層構造や食道胃接合部癌などの理解が深まり，胃癌の臨床的診断や治療とのかかわりも深くなってきた．本稿では，早期胃癌における形質発現分類の基礎的・臨床病理学的意義について，これまでの歴史と最近の知見を概説する．

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