ウイルムス腫瘍の病理組織学的検討(II) : 血管侵襲の分類とその評価

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Between 1962 and 1979, 29 patients of Wilms' tumor were treated in the Pediatric Surgical Department and Second Surgical Department, Chiba University, School of Medicine. Eleven were male and 18 female. In 17 patients, the right kidney was involved, in 7 the left, in 4 the bilateral, and in 1 patient the origin was extra renal. Eleven patients have survived without tumor to date, of whichsix have survived over 5 years. In 25 patients, it was possible to examined the involved kidney tissue. Each kidney was sectioned at least at 3 sites and the specimens were stained with Hematoxyline Eosinand Elastica van-Gieson. The vascular invasion was carefully studied histologically. In 7 patient with and 5 without pulmonary metastasis, the vascular invasion of the tumor in the kidney was preciselyexamined by serial section technique. The results were as follows: 1) Histological vascular invasionwas classified into 3 grades : v-0 without any invasion, v-1 with tumor cells observed in the capillaries of the kidney tissue and v-2 with tumor invations in the venules of the porta renalis. that isthe interlobar vein of the kidney. This grading correlated with 1) differentiation rate which was measured by the ratio of the volume of the gromerular and the tubular structures, 2) infiltration rateinto the normal kidney tissue and 3) metastatic rate to the lungs. The histological examination of vascular invasion seemed to be very important for predicting the future development of lung metastasis. 2) Histological examinations on vascular invasion must be performed on the central sagital section of the normal kidney, including the renal pelvis and the porta renalis. The serial section revealed presence of vascular invasion both in continuous and/or interrupted fashion for each patient. 3) The venules near the renal pelvis, that is the interlobar vein, had the significantly more occurrenceof vascular invasion. In the histological examinations, this site must be carefully observed. 4) Patients with pulmonary metastasis had the significantly more occurrence of vascular invasion. However,those with unfavorable factors of NWTS had more susceptibility of pulmonary metastasis. 5) If the occurrence rate of vascular invasion was followed to the Poisson' distribution statistically, the specimen in a patient with unfavorable factor must be examined with at least 30 sections and in others with at least 10 sections, for ruling out the presence of vascular invasion.
日本小児外科学会の論文
1980-12-20

ウイルムス腫瘍の病理組織学的検討(II) : 血管侵襲の分類とその評価

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