膀胱癌症例に対する膀胱粘膜多部位生検に関する研究 第4編: 膀胱粘膜多部位生検組織におけるThomsen-Friedenreich抗原の検討

Abstract

1980年3月より1984年7月までに施行した膀胱癌粘膜生検法のうち, 28症例, 35回の検索において1ヶ所以上の粘膜に上皮内癌または上皮内癌の微小浸潤が認められた.その生検粘膜201検体, 主腫瘍の生検組織27検体を対象にABC法を用いてT抗原およびcryptic T抗原を検出し, 臨床的意義を検討した.主腫瘍の組織学的異型度別のT抗原陽性率には有意差が見られなかった.組織学的所見別によるT抗原陽性率は上皮内癌の微小浸潤が有意に高く, cryptic T抗原陽性率は上皮内癌の微小浸潤が最も低値であった.T抗原およびcryptict抗原の有無による各種組み合わせの頻度は, 上皮内癌の微小浸潤が他の組織型と比較して正常型が少なく, 異常型が多い所見であった.生検部位と同一領域における累積非再発率は, T抗原陰性の領域が陽性の領域よりも有意に高く, 組織学的所見の層別検討では, 上皮内癌はT抗原陰性の領域が陽性の領域よりも累積非再発率が有意に高かった

The significance of Thomsen-Friedenreich antigen (T-Ag) in bladder carcinomas and multiple mucosal biopsies was studied. The T-antigen, a precursor of MN blood group antigen, is not found in normal cells, in which T-antigen is cryptic (cryptic T-Ag) but can be unmasked with neuraminidase digestion. Specimens of 27 main tumors and 201 mucosal biopsies from 28 patients with carcinoma in situ or microinvasion of carcinoma in situ were examined for the expression of T-antigen by Avidin-Biotin-Peroxidase Complex (ABC) method with peanut agglutinin (PNA). The T-Ag-positive rate was 22% for G2 tumors, 56% for G3 tumors, while cryptic T-Ag-positive rate was 86% for G2 tumors and 50% for G3 tumors. The correlation between T-antigen, cryptic T-antigen and histologic grade was not statistically significant. The T-Ag-positive rate in mucosal biopsies was 43% in microinvasion of carcinoma in situ, 11% in carcinoma in situ, 17% in transitional cell carcinoma, 8% in dysplasia, 33% in squamous metaplasia, 33% in proliferative cystitis and 13% in normal epithelium. Of histological findings, microinvasion of carcinoma in situ showed a significantly higher T-Ag-positive rate than carcinoma in situ and normal epithelium (P less than 0.005, P less than 0.001). The cryptic T-Ag-positive rate in mucosal biopsies was 38% in microinvasion of carcinoma in situ, 74% in carcinoma in situ, 100% in transitional cell carcinoma, 82% in dysplasia, 100% in squamous metaplasia, 100% in proliferative cystitis and 96% in normal epithelium. Of the histological findings, carcinoma in situ, proliferactive cystitis and normal epithelium showed a significantly higher cryptic T-Ag-positive rate than microinvasion of carcinoma in situ (P less than 0.025, P less than 0.05, P less than 0.001). Microinvasion of carcinoma in situ expressed the T-Ag (43%), the cryptic T-Ag (21%) and lacked the cryptic T-Ag (36%). Microinvasion of carcinoma in situ showed statistically significant difference in the mode of T-Ag and cryptic T-Ag expression than other histological types in mucosal biopsies, including carcinoma in situ (P less than 0.001).(ABSTRACT TRUNCATED AT 400 WORDS)