胃と腸48巻6号

2013年05月発行

今月の主題 微小胃癌の診断限界に迫る 主題

微小胃癌の病理―分化型微小胃癌の臨床病理学的および分子病理学的特徴

著者： 上杉憲幸¹ 菅井有¹ 織笠俊輔¹² 杉本亮¹ 遠藤昌樹² 鈴木一幸²

所属機関： ¹岩手医科大学医学部病理学講座分子診断病理学分野 ²岩手医科大学医学部内科学講座消化器肝臓内科分野

ページ範囲：P.794 - P.808

要旨　【目的】微小胃癌（5mm以下）の臨床病理学的および分子病理学的特徴の意義を明らかにするため，非微小胃癌（10mm以上）と比較検討した．【対象と方法】内視鏡的に切除された微小胃癌86例と非微小胃癌83例を対象とし，臨床病理学的事項，腫瘍グレード，背景粘膜および粘液形質について比較した．また，p53，MLH-1，β-cateninおよびKi-67について免疫組織化学的に解析した．さらに，癌および背景粘膜におけるDNAメチル化解析をLOX，MINT31，RUNX3，ELMO1，THBD，NEUROG1，SOCS1，p16，hMLH1の9遺伝子について行い，Yagiらの2パネル法に従って，DNAメチル化状態を分類した．【結果】微小胃癌では，（1）胃下部発生，（2）0-IIb型，（3）低グレード癌を示す症例が多かった．背景粘膜には両者に差はなかった．微小胃癌の粘液形質は胃型が少なく，小腸型が多かった．p53およびMLH-1発現は両者に差はなかったが，微小胃癌ではβ-cateninの核内蓄積の頻度が低かった．また，Ki-67陽性細胞の頻度と分布は両者に差はなかった．DNAメチル化では，微小胃癌は非微小胃癌と比較し，低メチル化状態の頻度が高く，高メチル化状態の頻度が低かった．背景粘膜のDNAメチル化に差はなかった．【結語】微小胃癌と非微小胃癌では，DNAメチル化の蓄積状態に差異があることが明らかとなった．

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