胃と腸56巻10号

2021年09月発行

今月の主題 胃上皮性腫瘍—組織分類・内視鏡診断の新展開 主題

腺窩上皮型腫瘍の新展開—腺窩上皮型胃腫瘍の内視鏡診断

著者： 柴垣広太郎¹ 三代剛² 福山知香² 高橋佑典² 古谷聡史² 大嶋直樹¹ 川島耕作² 石村典久² 長瀬真実子³ 荒木亜寿香³ 門田球一³ 石原俊治²

所属機関： ¹島根大学医学部附属病院光学医療診療部 ²島根大学医学部内科学講座（内科学第2） ³島根大学医学部器官病理学講座

ページ範囲：P.1287 - P.1298

要旨●H. pylori未感染者に発生するラズベリー様腺窩上皮型胃腫瘍とH. pylori既感染者に発生する腺窩上皮型胃癌の臨床病理学的特徴を検討した．前者は萎縮のない胃底腺領域に発生する発赤小隆起で，いわゆるラズベリー様外観を呈し，NBI拡大観察で不整な乳頭状/脳回様構造を呈した．後者は萎縮粘膜に発生する粗大な発赤隆起で，前者より大きく形態も歪であった．NBI拡大観察で乳頭状/脳回様構造を呈したが，形態不整は高度であった．病理組織学的には，前者はよく分化した上皮内病変で，WHO分類では多くがlow-grade dysplasia相当であったが，Ki-67 labeling indexは異型度によらず高値を示した．後者は構造異型・細胞異型が高度で，脱分化や脈管侵襲も認められ，胃型胃癌としての高い悪性度を示した．

参考文献

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