胃ポリープの臨床的観察 : 生検組織所見を中心に、特に加令、発生母地並びに癌化と関連して
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概要
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The histopathological and macroscopic classification of gastric polyps is still controversial. This study was performed to classify gastric polyps based on the gastroscopic view as well as the histopathological finding of biopsied specimens and to examine the histological alteration on aging and malignant transformaiton. During the period from Sept. 1960 to Sept. 1975, total 20,988 patients were examined by gastric endoscopy in Hyogo cancer hospital. There were 628 cases were operated and 44 cases were observed to have histological changes on surrounding mucosa of polyps. The results and conclusions are as follows. 1) Gastric polyps were divided endoscopically into 4 types; type Ss (Sessile, smooth-surfaced),type Si (Sessile, irregular surfaced), type Ps (Pedunculated, smooth) and type Pi (Pedunculated, irregular). Type Ss occurred the most frequent among 4 types. 2) Gastric polyps were grouped histologically into two, hyperplastic polyp (H. P.) and adenomatous polyps (A. P.). H. P. was conposed predominantly of non-atypical and hyperplastic gland ducts similar to gastric foveolae. A. P. was characterized by localized proliferation of atypical cells which closely resembled intestinal metaplasia. H. P. was seen in 86.7% of surgical cases and in 91.7% of biopsied cases. A. P. occurred in 13.3% and 8% in the surgical cases and biopsied cases respectively. 3) Study of relationship between endoscopic types and histology of gastic polyps revealed ; type Pi was the most common type of H. P. and type Si and Pi occupied almost A. P. in the surgical cases. Type Ss and type Si were the most common types in H. P. and A. P. respectively in the biopsied cases. 4) The incidence of gastric polyps appeared to increase in the older aged group. A. P. was seen much more than H. P. in the aged group. 5) The pathological follow-up study of biopsied specimens showed that no histological change in sequential biopsies was seen in H. P., and histological alteration seen in the A. P. were also minimal. During follow-up, no carcinomatous transformation was established both in H. P. and A. P .. 6) Histological study of surrounding mucosa of gastric polyps showed that atrophic gastritis and intestinal metaplasia were very high degree in incidence in the A. P. and these lesions might be associa ted with genesis of gastric polyps, however no histopathology was observed in the H. P .. Further study is required for the pathogenesis of H. P .. 7) Every on year follow-up is satisfactory for H. P. and every 3 to 6 months check-up is required for A. P.. Close observat ion is needed for A. P., especially if it is more than 2 cm in diameter in size.
- 神戸大学の論文