胃と腸46巻10号

2011年09月発行

形態診断に役立つ組織化学・分子生物学

―消化管間葉系腫瘍の診断―免疫組織化学染色

著者： 原田徹¹ 池上雅博¹

所属機関： ¹東京慈恵会医科大学附属病院病理部

ページ範囲：P.1551 - P.1561

文献概要

はじめに

　食道・胃・小腸・大腸から成る消化管に発生する間葉系腫瘍には様々な腫瘍が含まれるが，一般的には粘膜下腫瘍としての肉眼形態を呈してくることが多い．WHOの組織型分類によると，部位により多少の差はあるにせよ，平滑筋性腫瘍（leiomyoma，leiomyosarcoma），神経性腫瘍（schwannoma，neurofibroma），GIST（gastrointestinal stromal tumor），Kaposi肉腫，グロームス腫瘍，顆粒細胞腫，脂肪腫，悪性黒色腫，血管肉腫などが挙げられている^1）．組織形態診断上は，紡錘形細胞腫瘍，円形細胞腫瘍，多型細胞腫瘍に大きく分けられる．このうち最も遭遇する機会が多いのは紡錘形細胞腫瘍であろう．今回は紡錘形細胞腫瘍の頻度の高い疾患を中心に，免疫組織化学染色も含めて疾患を提示していく．

参考文献

1）Hamilton SR, Aaltone LA（eds）. World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Digestive System. IARC Press, Lyon, 2000

2）Mazur MT, Clark HB. Gastric stromal tumors : Reappraisal of histogenesis. Am J Surg Pathol 7 : 507-519, 1983

3）Miettinen M. Gastrointestinal stromal tumors. An immunohistochemical study of cellular differentiation. Am J Clin Pathol 89 : 601-610, 1988

4）Miettinen M, Virolainen M, Maarit-Sarlomo-Rikala. Gastrointestinal stromal tumors─Value of CD34 antigen in their identification and separation from true leiomyomas and Schwannnomas. Am J Surg Pathol 19 : 207-261, 1995

5）Hirota S, Isozaki K, Moriyama Y, et al. Gain of function mutation of c-kit in human gastrointestinal stromal tumors. Science 279 : 577-580, 1998

6）Nishida T, Hirota S, Taniguchi M, et al. Familial gastrointestinal stromal tumors with germline mutation of the KIT gene. Nat Genet 19 : 323-324, 1998

7）Miettinen M, Lasota J. Gastrointestinal stromal tumors（GISTs）: definition, occurrence, pathology, differential diagnosis and molecular genetics. Pol J Pathol 54 : 3-24, 2003

8）廣田誠一．GIST（Gastrointestinal stromal tumor）．日内会誌 93 : 165-171, 2004

9）Miettinen M, Lasota J. Gastrointestinal stromal tumors. review on morphology, molecular pathology, prognosis and differential diagnosis. Arch Pathol Lab Med 130 : 1466-1478, 2006

10）小池盛雄．腸管─腫瘍性疾患．向井清，真鍋俊明，深山正久（編）．外科病理学I，第4版．文光堂，pp 561-598，2006

11）Wadler P, Davorak AM. Gastrointestinal autonomic nerve（GAN）tumor. Ultrastructural evidence for a newly recognized entity. Arch Pathol Lab Med 110 : 309-316, 1986

12）Lauwes GY, Erlandson RA, Casper ES, et al. Gastrointestinal autonomic nerve tumor. A clinicopathological, immunohistochemical and ultrastructural study of 12 cases. Am J Surg Pathol 17 : 887-897, 1993

13）三上哲夫，寺田充彦，小田行一郎，他．いわゆるGastrointestinal autonomic nerve tumorの1例．病理と臨 13 : 1455-1460, 1995

14）下田忠和．胃．向井清，真鍋俊明，深山正久（編）．外科病理学I，第4版．文光堂，pp 427-502，2006

15）Heinrich MC, Corless CL, Duensing A, et al. PDGFRA activating mutations in gastrointestinal stromal tumors. Science 299 : 708-710, 2003

16）新長真由美，松田育雄，廣田誠一．消化器間葉系腫瘍（消化管と肝胆膵）の病理診断．臨消内科 22 : 1363-1371, 2007

17）廣田誠一．細胞表面レセプターと分子標的治療法．病理と臨 25（臨増）: 286-291, 2007

18）Fletcher CD, Berman JJ, Corless C, et al. Diagnosis of gastrointestinal stromal tumors : a consensus approach. Hum Pathol 33 : 459-465, 2002

19）Hasegawa T, Matsuno Y, Shimoda T, et al. Gastrointestinal stromal tumor : consistent CD117 immunostaining for diagnosis, and prognostic classification based on tumor size and MIB-1 grade. Hum Pathol 33 : 669-676, 2002

20）Hornick JL, Fletcher CD. The role of KIT in the management of patients with gastrointestinal stromal tumors. Hum Pathol 38 : 679-687, 2007

21）Sobin LH, Gospodarowicz MK, Wittekind Ch, et al（eds）. Gastrointestinal stromal tumour（GIST）: TNM Classification of Malignant Tumours, 7th ed. Wiley-Blackwell, UK, pp 78-81, 2009

22）Miettinen M, Sarlomo-Rikala M, Sobin LH, et al. Esophageal stromal tumors : a clinicopathologic, immunohistochemical, and molecular genetic study of 17 cases and comparison with esophageal leiomyomas and leiomyosarcomas. Am J Surg Pathol 24 : 211-222, 2000

23）Horiuchi A, Nikaido T, Taniguchi S, et al. Possible Role of Calponin h1 as a Tumor Suppressor in Human Uterine Leiomyosarcoma. J Natl Cancer Inst 91 : 790-796, 1999

24）Watanabe K, Kusakabe T, Hoshi N, et al. h-Caldesmon in leiomyosarcoma and tumors with smooth muscle cell-like differentiation : Its specific expression in the smooth muscle cell tumor. Hum Pathol 30 : 392-396, 1999

25）Yamaguchi U, Hasegawa T, Masuda T, et al. Differential diagnosis of gastrointestinal stromal tumor and other spindle cell tumors in the gastrointestinal tract based on immunohistochemical analysis. Virchows Arch 445 : 142-150, 2004

26）Gottlieb GJ, Ackerman AB. Kaposi's sarcoma. An extensively disseminated form in young homosexual men. Hum Pathol 13 : 882-892, 1982

27）橋本洋，遠城寺宗知．AIDSにおけるKaposi肉腫．日臨（別冊）: 104-109, 1987

28）遠城寺宗知，占部篤道．Kaposi肉腫．病理，病型と病因．日臨 45 : 646-653, 1987

29）Antoman K, Chang Y. Kaposi's sarcoma. N Engl J Med 342 : 1027-1038, 2000

30）Kaposi M. Idiopathisches multiples Pigmentsarkom der Haut. Arch Dermatol Syph 4 : 265, 1872

31）Folpe AL, Veikkola T, Valtola R, et al. Vascular endothelial growth factor receptor-3（VEGFR-3）: a marker of vascular tumors with presumed lymphatic differentiation, including Kaposi's sarcoma, kaposiform and Dabska-type hemangioendotheliomas, and a subset of angiosarcomas. Mod Pathol 13 : 180-185, 2000

32）Hisaoka M, Hashimoto H, Iwamasa T. Diagnostic implication of Kaposi's sarcoma-associated herpesvirus with special reference to the distinction between spindle cell hemangioendothelioma and Kaposi's sarcoma. Arch Pathol Lab Med 122 : 72-76, 1998

33）Robin YM, Guillou L, Michels JJ, et al. Human herpesvirus 8 immunostaining : a sensitive and specific method for diagnosing Kaposi sarcoma in paraffin-embedded sections. Am J Clin Pathol 121 : 330-334, 2004

34）片野晴隆，佐藤由子，佐多徹太郎．ヒトヘルペスウィルス8（HHV8）．病理と臨 21（臨増）: 102-109, 2003

35）恒吉正登，遠城寺宗知．顆粒細胞腫に関する臨床病理学的観察．福岡医誌 69 : 495-505, 1978

36）Johnston J, Helwig EB. Granular cell tumors of the gastrointestinal tract and perianal region : a study of 74 cases. Dig Dis Sci 26 : 807-816, 1981

37）石黒信吾．食道．向井清，真鍋俊明，深山正久（編）．外科病理学I，第4版．文光堂，pp 397-426，2006

38）橋本洋．軟部腫瘍．向井清，真鍋俊明，深山正久（編）．外科病理学II，第4版．文光堂，pp 1511-1596，2006

39）Carroll RE, Berman AT. Glomus tumors of the hand : review of the literature and report on twenty-eight cases. J Bone Joint Surg Am 54 : 691-703, 1972

40）Tsuneyoshi M, Enjoji M. Glomus tumor : a clinicopathologic and electron microscopic study. Cancer 50 : 1601-1607, 1982

41）Wille P, Borchard F. Fibroid polyps of intestinal tract are inflammatory-reactive proliferations of CD34-positive perivascular cells. Histopathology 32 : 498-502, 1998