膀胱腫瘍の病理組織学的研究 第2報 : 局所リンパ濾胞・immunoblast cellの意義について

Abstract

膀胱腫瘍の先端部にみられるリンパ球の集積像(局所リンパ濾胞と略す)の臨床病理学的意義ならびに全身性免疫能との関係について若干の検討を加えた.1)細胞性間質反応の疲度の差により, 予後に有意な差が認められた.2)局所リンパ濾胞内には, immunoblast cell-transformed lymphocyteが認められ, その濾胞の直径が大きくなる程immunoblast cellが多く観察され, その局在は局所リンパ濾胞の周辺部位に集積する傾向が認められた.3)病理組織学的深達度ならびに異型度との検討にて, 局所リンパ濾胞・immunoblast cellはpT1～pT2群, G2群に多く観察された.4)細胞性間質反応が強くあらわれた群またはimmunoblast cellの多く観察された群では, SI値は高値を, Trは低値を示す傾向が認められた.T cell, B cellと局所リンパ濾胞・immunoblast cellとの間に一定の傾向は認められなかった.5)膀胱腫瘍の先端部における局所リンパ濾胞(immunoblast cellも含めて)は全身性免疫能の腫瘍局所での組織表現のひとつと考える

The relationship between the cellular stromal reaction and systemic immunity was examined in 34 cases of bladder tumors. To determine the cellular stromal reaction, we examined the local lymph follicles such as peritumoral lymphocyte accumulation, and the immunoblast cells having abundant, basophilic cytoplasm with large vesicular nuclei which contained 1-3 large and irregular nucleoli. To measure systemic immunity, lymphocytes, T cells, B cells, IgG-Fc receptor T cells, and lymphocyte blast formation ratio with PHA were examined. The survival rate was higher in the group with a strong stromal reaction. The distribution of the immunoblast cells showed a tendency to accumulate in the paracortical area of the local lymph follicles. Examination of the depth of tumor infiltration and grade revealed many local lymph follicles and immunoblast cells in pT 2 and G 2 groups. The groups in which lymph follicles and/or immunoblast cells were positive showed a tendency of high lymphocyte blastformation ratio with PHA accompanied by a low percentage of IgG-Fc receptor T cells. These findings suggest that local lymph follicles and immunoblast cells may be a manifestation of the systemic immunity acting as a tumor defense mechanism.