| 特集名 | EMRの問題点 | |
|---|---|---|
| 題名 | EMR標本の評価と局所の遺残再発 (2) EMR症例の評価 --腫瘍の病理組織像と生長速度，リンパ節転移の観点から | |
| 発刊年月 | 1999年 01月 | |
| 著者 | 味岡 洋一 | 新潟大学医学部第一病理 |
| 【 要旨 】 | 要旨はありません。 | |
| Theme | Problems of endoscopic mucosal resection in colorectal neoplasia | |
|---|---|---|
| Title | Pathologycal evaluation of endoscopically resected colorectal neoplasms | |
| Author | Yoichi Ajioka | 1st Department of Pathology, Niigata University School of Medicine |
| [ Summary ] | For the evaluation of endoscopically resected colorectal neoplasms, we stressed the importance of judging the histological grade of atypia carcinoma, from the stand point of tumor growth rate, risk of submucosal invasion and incidence of lymphnodal metastasis. A knowledge of the growth (regenerative) rate of tumors by their histological grade of atypia and the risk of submucosal invasion are important in deciding on the correct follow up protocol, if the endoscopic resection was judged as incomplete. Using Collins' equation with a Ki-67 index and an apoptotic index for proliferating cell rates and cell loss rates, respectively, the growth (regenerative) rates of high grade carcinoma were shown to be much more rapid than those of low grade carcinoma, which showed no significant difference from tubular adenoma. Furthermore, high grade carcinoma were revealed to commence submucosal invasion when the mucosal lesion was far smaller than that of low grade carcinoma, suggesting a higher submucosal invasion risk for high grade carcinoma compare to low grade carcinoma. When endoscopically resected lesions prove to be submucosal carcinoma, evaluation of the risk for lymphnodal metastasis becomes essential. Lymphnodal metastasis was not present in low grade submucosal carcinoma. Assessment of the grade of submucosal invasion becomes important when the invasive carcinoma is of a high grade. Lymphnodal metastasis begins to appear when the vertical length of the submucosal invasion exceed 1,000 pm and the horizontal length exceeds 3,000 pm. Whether or not macroscopic types of carcinoma may be a significant additional factor in evaluating the risk of lymphnodal metastasis must be examined through further research. |
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