膀胱癌の病理学的研究 - 癌病巣と増殖性膀胱炎について -

Abstract

膀胱癌患者の膀胱全摘除標本33例を対象として, 連続平行割面法による病理組織のmappingを行ない, 癌病巣と増殖性膀胱炎との関係を検討した.増殖性膀胱炎つまり粘膜の下方増殖(DG)の検出頻度は94%と高く, 膀胱粘膜全般に認められた.組織型別DG検出頻度はsimple DGが94%, cystic DGが58%, clear cell DGが18%, intestinal like cell DGが3%であった.flat CISとDG型のCISを区別してみると, DG型のCISがある場合には管内性浸潤を起こしやすいと考えられ, flat CISとDG型CISとは病理組織学的に区別さるべきと思われた.DGの島状分離像は標本作製部位の違いにより観察されるものと考えられ, 下方増殖の特殊例として筋層内にDG像が認められた2例を経験, またinverted papillomaがDGの過形成である可能性を示唆する所見を得た

Thirty-three cases of urinary bladder cancer treated by radical cystectomy were reviewed. All of these specimens of the bladder were histologically examined by step sections of the entire bladder. According to the analysis of schematic illustration, downgrowth proliferation (DG) of the bladder epithelium was observed in whole bladder mucosa, particularly at the trigone and posterior dome, and it was seen in 94 % of all examined cases. Following Yamada's classification, DG was divided into 4 histological types, 1) simple DG, 2) cystic DG, 3) clear cell DG and 4) intestinal-like cell DG. In general, the frequency of each DG has no significant relationship to cancer, age or inflammatory cell infiltration. Only clear cell DG, however, was frequently observed around carcinoma lesions. Isolated DG lesions were seen in the submucosa. Although these lesions appeared to be separated from the epithelial layers, observation of serial sections showed clearly that they were a continuous lesion. Carcinoma in situ of urinary bladder could be divided into flat type and DG-type according to their histological pattern. The latter had the tendency to extend intraductally to the prostate at an early stage. Microfocus of carcinoma in a part of DG-lesion was sometimes found. Therefore, the possibility of malignant change of DG was suggested.