Lehnert T, Erlandson R A, Decosse J J
Gastroenterology. 1985 Nov;89(5):939-50. doi: 10.1016/0016-5085(85)90192-1.
The distribution of lymph and blood capillaries has been studied by light and transmission electron microscopy in 16 endoscopic and surgical specimens of human gastric mucosa and submucosa. Four specimens were completely normal, seven showed mild gastritis, and five showed severe gastritis. On light microscopy, no definite distinction could be made between small mucosal lymph and blood capillaries. The distinction was achieved only by transmission electron microscopy where lymph capillaries could be identified by the presence of anchoring filaments and the demonstration of open gaps and overlapping endothelial cell processes, as well as by the absence of a basement membrane and "fenestrations" typical of the endothelial cells of blood capillaries. Although large lymph vessels were observed in the submucosa, lymph capillaries were found only in the deep lamina propria adjacent to and within the muscularis mucosae. The upper and middle levels of the lamina propria of the gastric mucosa contained no lymph capillaries. The entire mucosa showed a rich supply of blood capillaries, many of which were adjacent to the basal lamina of gastric glands and the surface epithelium. These morphologic findings correlate with clinicopathologic observations on early gastric cancer. The particularly low incidence of lymph node metastases in the subtype of early gastric cancer that remains confined to the mucosa may be explained by the rarity of lymph capillaries in the mucosa. The high percentage of blood-borne metastases in recurrent early gastric cancer may be related to the rich vascularity of gastric mucosa.
运用光学显微镜和透射电子显微镜，对16例人胃黏膜及黏膜下层的内镜和手术标本中的淋巴管和毛细血管分布进行了研究。4例标本完全正常，7例显示轻度胃炎，5例显示重度胃炎。在光学显微镜下，无法明确区分黏膜内的小淋巴管和毛细血管。只有通过透射电子显微镜才能实现区分，其中淋巴管可通过锚定丝的存在、开放间隙和内皮细胞重叠过程的显示以及缺乏毛细血管内皮细胞典型的基底膜和“窗孔”来识别。虽然在黏膜下层观察到了大淋巴管，但仅在紧邻黏膜肌层并位于黏膜肌层内的固有层深部发现了淋巴毛细管。胃黏膜固有层的上层和中层没有淋巴毛细管。整个黏膜显示出丰富的毛细血管供应，其中许多毛细血管紧邻胃腺的基膜和表面上皮。这些形态学发现与早期胃癌的临床病理观察结果相关。局限于黏膜的早期胃癌亚型中淋巴结转移发生率特别低，可能是由于黏膜中淋巴毛细管稀少所致。复发性早期胃癌中血行转移的高比例可能与胃黏膜丰富的血管有关。
