著者

藤井 大輔 栗田 啓 高嶋 成光

出版者

Japan Surgical Association

雑誌

日本臨床外科学会雑誌 (ISSN:13452843)

巻号頁・発行日

vol.62, no.12, pp.2918-2922, 2001

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慢性関節リウマチの経過観察中に早期胃癌を発症し,それに対する幽門側胃切除術施行時に得られた小腸片より続発性消化管アミロイドーシスの確定診断を得た1例を経験した.症例は72歳,女性.近医にて慢性関節リウマチの治療のために入退院を繰り返していた.健康診断目的で受けた胃内視鏡にて早期胃癌を認めたため,治療目的で当院へ紹介された.早期胃癌の診断の下に幽門側胃切除術を行った.手術施行時に得られた空腸の一部を病理標本として提出,検討した.組織学的には,粘膜下層に分布する小型~中型の血管壁に好酸性物質の沈着,硝子化を散存性に認めた.同部位の特殊染色結果はAA typeのアミロイドーシス蛋白の沈着を示し慢性関節リウマチに続発した消化管アミロイドーシスと考えられた.消化管アミロイドーシスは,本症例のように胃癌が併発していることもあり,慢性関節リウマチに対しては定期的に内視鏡検査を行う必要があると考えられた.

著者

高嶋 成光

出版者

岡山医学会

雑誌

岡山医学会雑誌 (ISSN:00301558)

巻号頁・発行日

vol.89, no.3-4, pp.333-360, 1977-04-30 (Released:2009-03-30)

参考文献数

57

被引用文献数

1

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Clinicopathological studies of the histogenesis of the thyroid cancer on the emphasis of morphological features and growth pattern of the occult thyroid carcinoma measuring under 1.0 cm in diameter obtained at autopsy and surgery were performed.The occult thyroid carcinoma observed from the routine section of the thyroid gland obtained from 500 cases at autopsy and 259 cases at surgery were 21 cases (4.2%) and 10 cases (3.9%), respectively. Histological typing were 25 cases of papillary adenocarcinoma and 6 cases of follicular adenocarcinoma.Papillary adenocarcinoma cases were subdivided histologically into sclerosing, cystic and non-sclerosing types. The sclerosing type showed the proliferation of the fibrous connective tissue in the tumor and lymphogenous metastasis with intraglandular metastasis.One case of surgically obtained sclerosing type showed the recurrence and death. The cystic type were enclosed by the capsule and morphologically papillary cystadenocarcinoma. The non-sclerosing type did not show the fibrous connective tissue or capsular formation and smaller compared to the above 2 types. This type suggests the early stage of papillary adenocarcinoma histogenetically.Follicular adenocarcinoma cases were diagnosed according to the atypism of the tumor tissue and in 3 cases capsular formation was observed and in the other cases tumor tissue was directly attached to the thyroid tissue.Metastatic thyroid cancer was found in 12 cases (3.4%) among 349 autopsy cases of the malignant neoplasia. The mode of growth was either diffuse infiltration or solitary nodular formation in the thyroid tissue.Tumor like lesion (51cases, 10.2%) was correspond to the so-called solid cell nest and suggested the squamas metaplasia according to the histological finding of the early histogenesis.