Nagamoto N, Saito Y, Suda H, Imai T, Sato M, Ohta S, Kanma K, Sagawa M, Takahashi S, Usuda K
Department of Surgery, Tohoku University, Sendai, Japan.
Am J Surg Pathol. 1989 Jan;13(1):11-20. doi: 10.1097/00000478-198901000-00002.
This study was designed to verify our hypothesis that there are two different growth types in roentgenographically occult squamous cell carcinoma of the bronchus. Serial blocks prepared from the entire bronchial tree of 83 resected specimens of occult carcinoma were used for the evaluation of the relationship between the length of longitudinal extension and the maximal depth of transmural invasion. We prepared a length-depth diagram of 92 lesions, including multifocal carcinomas, which confirmed that there are at least two types: Most of these lesions are of the creeping type, which shows a marked superficial growth; the minority are of the penetrating type, which shows a marked downward growth. The diagram suggests that occult carcinoma has a propensity either for longitudinal growth along the bronchial lumen or for transmural growth into the bronchial wall at the time of occurrence. It is likely that the penetrating type grows rapidly and becomes advanced in a short time. Identification of longer lesions of the creeping type is occasionally problematical both at bronchoscopy and at surgical treatment. The stump is usually positive for carcinoma unless frozen sections or imprint specimens of the margin of resection are examined, because it is frequently difficult to identify the proximal end of extension by bronchoscopy.
本研究旨在验证我们的假设，即支气管X线隐匿性鳞状细胞癌存在两种不同的生长类型。从83例隐匿癌切除标本的整个支气管树制备系列切片，用于评估纵向延伸长度与透壁浸润最大深度之间的关系。我们绘制了92个病变（包括多灶性癌）的长度-深度图，证实至少有两种类型：这些病变大多数为匍匐型，表现为明显的浅表生长；少数为穿透型，表现为明显的向下生长。该图表明隐匿癌在发生时倾向于沿支气管腔纵向生长或透壁生长至支气管壁。穿透型可能生长迅速并在短时间内进展。在支气管镜检查和手术治疗时，识别较长的匍匐型病变有时存在问题。除非检查切除边缘的冰冻切片或印片标本，残端通常为癌阳性，因为通过支气管镜检查常常难以确定延伸的近端。
