Kraus B, Cain H
Pathol Res Pract. 1979 Jan;164(3):342-55. doi: 10.1016/S0344-0338(79)80054-0.
Carcinoma in situ, a precancerous lesion in the strict sense, was first recognized in stratified squamous epithelia. It is characterized by markedly atypical cells replacing the autochthonous epithelial cells without stromal invasion, the basement membrane being well preserved. Notwithstanding gradual transitions between carcinoma in situ on the one hand and dysplasias and invasive cancer on the other hand, its histological separation from the latter is feasible in the uterine portio. Its recognition has decisive therapeutic and prognostic implications, particularly in view of the frequently observed latent period between purely superficial spread and early invasive growth. In contrast difficulties are encountered in applying the concept of Carcinoma in situ to mucosal lesions of the stomach, though an analogous replacement stage has to be postulated, because the gastric and cervical mucous membranes differ fundamentally in their structural characteristics. The epithelial cells of the surface, pits and tubular glands do exhibit progressive atypia during cancerization. However, the single-layered epithelium offers far less distinctive criteria than the stratified squamous epithelium. Newly formed glandular complexes cannot be accepted as evidence for in situ growth. The latent period between purely superficial replacement by atypical cells and invasion appears to be considerably shorter in the stomach than in the portio, probably because the mechanical resistance of the loosely textured gastric lamina propria is small. In addition, stromal invasion may originate from any one epithelial cell in the gastric mucosa, whilst it is just the basal layer from which invasively growing cells may emanate in the uterine portio. The occurrence of dysplasia in the mucosa of the stomach does not justify a gastrectomy, according to our current experience, there being no intervention in gastric surgery equivalent to that of conization.
原位癌，严格意义上的一种癌前病变，最早在复层鳞状上皮中被认识到。其特征是明显异型的细胞取代了自身的上皮细胞，而无基质浸润，基底膜保存完好。尽管原位癌与发育异常及浸润性癌之间存在逐渐过渡，但在子宫颈部位，将其与后者进行组织学区分是可行的。其识别具有决定性的治疗和预后意义，特别是考虑到在单纯浅表扩散和早期浸润性生长之间经常观察到的潜伏期。相比之下，将原位癌的概念应用于胃黏膜病变时会遇到困难，尽管必须假定存在类似的替代阶段，因为胃黏膜和宫颈黏膜在结构特征上有根本差异。在癌变过程中，表面、腺窝和管状腺的上皮细胞确实会出现进行性异型性。然而，单层上皮提供的特征标准远不如复层鳞状上皮明显。新形成的腺性复合体不能被视为原位生长的证据。在胃中，由异型细胞进行单纯浅表替代到发生浸润之间的潜伏期似乎比在子宫颈部位短得多，这可能是因为质地疏松的胃固有层的机械阻力较小。此外，基质浸润可能起源于胃黏膜的任何一个上皮细胞，而在子宫颈部位，浸润性生长的细胞可能仅起源于基底层。根据我们目前的经验，胃黏膜发育异常的发生并不足以进行胃切除术，在胃部手术中没有与宫颈锥切术相当的干预措施。
