Takahashi T, Iwama N
Virchows Arch A Pathol Anat Histopathol. 1984;403(2):135-48. doi: 10.1007/BF00695230.
The pathogenetic relationship of gastric adenoma to carcinoma remains unsettled, partly due to the difficulty in discriminating between the atypical tubules of adenoma and those of adenocarcinoma. Although it has been said that this discrimination should depend not only on cellular changes but also on disorganization of glands, the latter has not been described in accurate morphological terms. In view of this, gastrectomy specimens from three patients with tubular adenoma were submitted to graphic reconstruction of atypical glands from serial sections, and were compared with well differentiated adenocarcinoma and metaplastic mucosa. Reconstruction disclosed that in adenoma, unlike in metaplastic mucosa, atypical tubules had multiple connections with adjacent ones, forming a network. At some sites of anastomosis the lumen was also connected. Though this pattern was similar to that of well differentiated adenocarcinoma, the meshes of the network were much more coarse than in the latter, showing that adenoma was a mere miniature of adenocarcinoma. The porous structure, the commonest architecture of adenocarcinoma, was never found in adenoma. There were in addition giant glands with complicated branching which, together with microcysts forming at mucosal bottom, caused convolution and twisting of tubules, producing those abnormal patterns in section on which too much stress is placed.
胃腺瘤与癌之间的发病关系尚未明确，部分原因在于难以区分腺瘤的非典型小管与腺癌的非典型小管。尽管有人认为这种区分不仅应取决于细胞变化，还应取决于腺体的结构紊乱，但后者尚未用准确的形态学术语进行描述。鉴于此，对3例管状腺瘤患者的胃切除标本进行了连续切片非典型腺体的图像重建，并与高分化腺癌和化生黏膜进行了比较。重建结果显示，与化生黏膜不同，腺瘤中的非典型小管与相邻小管有多个连接，形成一个网络。在一些吻合部位，管腔也是相连的。尽管这种模式与高分化腺癌相似，但网络的网眼比后者粗得多，表明腺瘤只是腺癌的一个缩影。腺癌最常见的结构——多孔结构，在腺瘤中从未发现。此外，还有具有复杂分支的巨大腺体，它们与黏膜底部形成的微囊肿一起，导致小管卷曲和扭曲，在切片上产生那些被过度强调的异常模式。
