The Study with Dissecting Microscope on the Gastric Mucosa of Polypoid Lesions
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概要
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When used in conjunction with the dissecting microscope, by means of which magnification and three dimensional observation are realized, the gastrofiberscope will reveal a more minute structure of the gastric mucosa, and thus provides a mors accurate diagnosis. Polypoid lesions of the stomach are often difficult to diagnose correctly, and to differentiate from malignant lesions, with the conventional gastric endoscope. As a preliminary study, the author has examined the gastric mucosa of polypoid lesions under the dis secting microscope. Sixty two biopsy specimens, obtained from 35 cases under direct vision with the gastro-fiberscope, and 11 resected stomachs were studied. The biopsy materials consisted of 21 specimens from polyps, 17 of atrophic hyperplastic gastritis, 18 normal and 6 others. Among the resected stomachs, 8 had polyps (22 studied in total) with or without xanthoma (9 studied in total), 2 had early cancer of type ha, and the other one had submucosal tumor. These specimens were examined freshly under the dissecting microscope with magnification raging from 6.3 to 40 times as soon as the specimens were robtained, and photographed in color simultaneously. Then the specimens were fixed with f ormalin solution for patho-histological examination, and the results were compared with the dissecting microscope appearances. The results are as follows : 1) Normal gastric mucosa The normal gastric mucosa reveals uniformly distributed gland openings and each of them is surrounded by a slightly elevated semitransparent wall. A gland opening with surrounding wall may be regarded as a unit. In the normalfundic gland area, the gland openings are mainly round, and when small, recognized as pin point holes. Each unit resembles a dough-nut. The whole mucosal pattern gives honeycomb-like appearance, and granular appearance, when pin point gland openings gather. Usually a few capillaries are seen around the opening along the inner side of the wall. On the other hand, the normal pyloric gland area shows elliptical or slit-like gland openings with surrounding wall similar to that in the fundic gland area; each unit is oval, giving fish-scale like appearance. The capillaries ars similar to those of the fundic mucosa. 2) Atrophic hypeprlastic gastritis Remarkable changes of mucosal pattern in atrophic hyperplastic gastritis are irregularity in shape and variable increase in size of the units ; they often elongate in the long axis, sometimes showing mountain range or convolution-like pattern. 3) Polyp In polyp, those changes seen in atrophsc hyperplastic gastritis are more prominently noticed. Swelling of the surroundging wall and increased vascularity are also frequent findings. 4) Early gastric cancer (Type IIa) The mucosal surface involved with cancer becomes even, flattened, and structureless. Only scattered disintegrated or shrinked units are found. The capillaries become irregular in pattern, and quite different from that of the normal. The above-described dissecting microscope findings are notieced in involved area even with no remarkable macroscopic changes, and clearly different from the neighbouring uninvolved mucosa. 5) Xanthoma In smaller xanthoma, there is slight focal yellowish discoloration in the wall of some units, but well developed xanthoma reveals many clearly outlined deeper yellow mucosal areas closely adjoining to one another, which are irregular in shape and variable in size, giving rise to stone-wall or pavement-like pattern. Gland openings are eventually invisible. 6) Submucosal tumor Noteworthy changes are not observed in the mucosa over submucosal tumor except for irregular pattern with variable size of the units. Study of the gastric mucosa of polypoid lesion under the dissecting microscope is a simple and very useful procedure for differential diagnosis. Therefore the development of the gastro-fiberscope provided with the function of the dissecting microscope is highl
- 社団法人 日本消化器内視鏡学会の論文