膀胱癌に関する研究 第3編: 悪性度に関する病理組織学的研究 (予後に影響をおよぼす組織像の分析と抽出)

Abstract

Palhohistological studies on the malignancy of carcinom a of the urinary bladder, which might give influences to the prognosis of patient, were carried out on total of 175 cases examined at the urology clinic of the Kyoto University Hospital, consisting of 129 cases in whom all layers section was availalbe and of 46 cases in whom histological examination of the bladder other than the leading area of the tumor was feasible. The results are sunmarized as follows. 1) Classification of all cases by cell type of the tumors showed that as Table 2 indicates, pure transitional cell carcinoma 129 cases (73.7%), pure squamous cell carcinoma 16 cases (9.1%), undifferentiated carcinoma 15 cases (8.6%), 'transitional cell carcinoma with squam ous area 5 cases (2.9%) and adenocarcinoma or adenomatous cell tendency 5 cases (2.9%). The progrosis indicated by 5 years survival rate in each group of transitional cell, squamous cell and undifferentiated cell carcinomas was 54.2%, 18.8%, and 12.1%, respectively (Fig. 1, Table 3). 2) Distribution of 129 cases of transitional cell carcinoma classified according to histolo g ical grading of the American Bladder Tumor Registry showed that grade I 37.2%, grade II 22.5 %, grade III 27.1% and grade IV 13.2%. The 5 years survival rate in each of grade I, II, III and IV groups was 87.4%, 52.3%, 22.2%, and 0%, respectively (Fig. 2, Table 5). Sixteen cases of squamous cell carcinoma were also divided by same criteria into 5 cases of grade II, 6 of grade III and 5 of grade IV, and their progrosis was the worse in the more undifferentiated types. 3) The relationship between the staging of infiltration and the grading of differentiation showed that, as seen in Table 6, the more undifferentiated types consisted of the more proportions of severe infiltration. As shown in Fig. 3, the 5 years survival rate in each group was stage 0 87.6%, stage A 24.8%, stage B1 43.6%, stage B2 0% and stage C 10.9%. It was demonstrated that the prognosis was in generally similar between stage A and B1 as well as between stage B2 and C (Table 7). 4) Presence or absence of i n travascular tumor-cell emboli in the bladder wall gave serious significance on prognosis. Relationship between intravascular emboli and grade of cell differentiation or stage of infiltration confirmed that the higher incidence of emboli was evident in the more undifferentiated or more infiltrated cases. In addition, cases with tumor-cell emboli had worse prognosis than without emboli, and the fact was also true when the comparison was made among cases with same staging (Fig. 4, Table 8, 9, 10). 5) Prognosis was also evaluated in regard to mode o f infiltration . It was demonstrated that prognosis was best in en bloc invasion, followed by tentacular invation and worst in lymphatic spread (Fig. 5, 6, Table 11, 12). 6) Fibrous reaction of interstitia l tissue in the leading area of the tumor was noticed to show protecting significance of the tumor-bearing subjects. It was found that the cases with fibrous proliferation in the interstitial tissue of the leading area have better prognosis than cases without such proliferation. Furthermore cellular reaction of interstitial tissue in the leading area was most efficient when exudating cells completely surround the leading area of the tumor. Prognosis in such cases was confirmed to be better than in cases with incomplete surrounding type. As the exudative cell elements, plasma cells and lymphocytes often exhibit complete surrounding type while neutrophils and eosinophils usually display incomplete surrounding type (Fig. 7, 8, 9, Table 13, 14, 15, 16, 17). 7) Based on the above mentioned findings, it was concluded that the histological pictures which may concern the prognosis of cancer of the urinary bladder are a) cell type of the tumor, b) grade of cell differentiation, c) stage of infiltration, d) tumor-cell emboli in the bladder wall, e) mode of infiltration and f) interstitial fibrous reaction and interstitial cellular reaction with certain forms. It will be emphasized that detail examination of such histological pictures are essential on pathohistogical study of cancer of the urinary bladder.