胃溃疡癌组织学诊断标准的探讨

Histologic Criteria for the Diagnosis of Ulcer Cancer of Stomach

通过对良、恶性胃溃疡的系列切片观察,证明修改后的Hauser标准对诊断溃疡癌是基本适用的,但尚不能将进展期溃疡癌与癌溃疡区分。本文观察到山峰状疤痕为早、晚期溃疡癌共同的组织学特征,凭此可检出进展期溃疡癌。为便于区分,建议胃溃疡癌的诊断标准为:①将溃疡做不同方位“＊”形多切片,证明溃疡周围1cm以内粘膜无癌灶,以除外溃疡与先在的癌碰合的可能性。②溃疡底全层由山峰状疤痕所代替,其中既无癌浸润亦无肌残留,常见厚壁血管、神经纤维增生和神经节细胞变性。③溃疡周边多见粘膜肌与肌层靠近甚至融合。④癌以早期或进展期状态存在于溃疡一侧、周边或侵至山峰状疤痕底部。

Through serial section Study of a series of gastric surgical specitmens(1 1 1 benisn ulcer, 31 ulcer can- eer, and 133 ulcerative cancer),the author concluded that modified Hauser's criteria Can be applied in the diagnosis of ul- cerative carcinoma,however, by using thase criteria,one can not distinguish advanced ulcer cancer from carcinotnatous ul- cer. Meanwhlle,the author observed that the heaved scar was the common histologic feature both in early and advanced ul- cer cancer. It is suggested that the histologic criterta of ulcer cancer should include: (1)In order to exclude the possibility of an ulcer being coexistent with a pre-existing carcinoma, multiple slices of tissue Should be taken in different directions according to'*'pattern to be sure that there is no cancerous lesion within 1cm at the periphery of the ulcer. (2)The base of the ulcer is composed of heaved scar, neither carcinomatous infiltration nor residual museular layer be found. On the contrary, thickencd veasel walls, nerve fibers proliferation, and nerve-ganglion cells degeneration are common. (3)The muscularis mucosa be fused with tunica muscularis is seen at the margin of the ulcer. (4)Either early or advanced,the can- cerous lesion may be found on one side,or surrounding the ulcer,or invading the bottom of the heaved scar.