INTESTINE Vol.23 No.1(4-1)


特集名 大腸内分泌細胞腫瘍─WHOの考え方と日本の考え方
題名 直腸カルチノイド (1) 病理診断
発刊年月 2019年 02月
著者 河内 洋 がん研究会有明病院病理部
【 要旨 】 直腸カルチノイド腫瘍は,本邦においては大腸カルチノイド腫瘍の9割以上を占め,もっとも頻度が高い.肉眼的には粘膜下腫瘍様形態を示すが,増大すると粘膜面への露出もみられる.組織学的には索状,リボン状,管状,小胞巣状,充実性胞巣などの組織構築を示す.腫瘍細胞は類円形~楕円形で粗大顆粒状クロマチンを有する比較的均一な核と,淡好酸性で繊細な顆粒状細胞質をもつ.免疫染色ではシナプトフィジンやCD56が通常陽性だが,クロモグラニンAの陽性率が低い等,他臓器発生との違いがある.実際の病理診断では壁深達度や脈管侵襲,断端等,通常記載する項目に加え,核分裂数やMIB-1 indexによる増殖指数の評価を行い,それに基づくWHOグレード分類も記載する.生検診断においては,粘膜下腫瘍様病変であるため,粘膜表層からの検体採取では診断に至らない可能性があり,深部まで含めた検体採取や複数個の生検が望ましいが,病変が小さい場合は治療時に影響が及ぶおそれがあることにも留意する.本邦の分類は組織所見に基づくが,WHO分類は細胞増殖指数による分類であり考えが異なっている.
Theme Endocrine cell tumors of the colorectum: Difference in concept between WHO classification and Japanese classification
Title Pathological diagnosis of rectal carcinoid tumor
Author Hiroshi Kawachi Department of Pathology, The Cancer Institute Hospital, Japanese Foundation for Cancer Research
[ Summary ] Rectal carcinoid tumors are the most frequent carcinoid tumor of the colorectal region, accounting for more than 90 % of such tumors in Japan. Macroscopically, these tumors exhibit a submucosal tumor-like appearance and occasionally reveal tumor progression on the mucosal surface. Histologically, these tumors show trabecular, ribbon-like, tubular, small alveolar, or solid architecture. Tumor cells contain uniform round or oval nuclei with coarse chromatin and slightly eosinophilic fine-granular cytoplasm. Immunohistochemically, synaptophysin and CD56 are usually positive, but chromogranin A shows negative or focally positive results. In the practical histopathological diagnosis, WHO grades should be described as well as conventional findings such as tumor depth, lymphovascular invasion, and resection margin. In the mucosal biopsy diagnosis, it is occasionally difficult to obtain a sufficient amount of tumor cells for diagnosis because of the submucosal tumor-like shape, therefore larger sample or multiple samples are recommended. There is a difference in diagnostic criteria for neuroendocrine tumor between Japan and WHO, that is, the former in based on the histologic findings and the latter is based on the proliferative index.
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