ਸ਼  ৚঩ম୰৶৾ভ੕ভ॥থঃॽड़থ঑‫ॸش‬ॕথॢ ঩মഎযఐ୰৶৾ভ਴ਛ  ফ  া  ঩ ਎௝উছ२঍ॸঝ( ভৃ‫ ق‬మِّႍ‫ع ك‬੓ਙभ෗ೕ‫؞‬໅Ⴭभ୰৶ड़‫ش‬फ़ॼॖ२‫؞ش‬ౠশ஬ਆ ௼৕‫ূق‬਎ჩ౩ভୢఐপ৾ ୰৶৾൥ౠ‫ك‬ਕ঱ ໙ಜ‫ق‬ിমপ৾ୢ৾৖ဟര୰੹ ୰৶൧૵ఐ‫ك‬&0  ෗ೕ‫؞‬໅ᒷ৔୰૗भ୰৶൧૵
ਕ঱ ໙ಜ‫ق‬ിমপ৾ୢ৾৖ဟര୰੹ ୰৶൧૵ఐ‫ك‬

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&0  ੓ਙभ໅Ⴭபਙরຜᇯधजभ༓શ൧૵஬ਆ ௼৕‫ূق‬਎ჩ౩ভୢఐপ৾ ୰৶৾൥ౠ‫ك‬ঁথॻ॔क़ॺभ 3') ই॓ॖঝ॑঩মഎযఐ୰৶৾ভभ঍‫ش‬঒ঌ‫ش‬४ऊैॲक़
থট‫ॻش‬घॊऒधऋदऌऽघ‫ق‬KWWSMVJ\SRUJ‫ك‬  ਰৣभ 45 ॥‫॑ॻش‬௚ఝਗ਼ਵ‫ؚ‬५ঐ‫ॺش‬ইज़থभढ़ওছद਄ॉ੢ा‫ؚ‬࿌ൗऔोथः
ॊ 45 ॥‫ॻش‬ഭ਄ॉਃચ॑ઞ৷खथ॔ॻঞ५‫ق‬85/‫ك‬प૗ఌघॊऒधपेढथ঍‫ش‬঒ঌ‫ش‬४प॔ॡ७५ऋ૭ચधऩॉऽघ‫؛‬എযఐ୰৶৾ভ‫ق‬ઉৢ‫ك‬ਸ਼  ৚୰৶৾ভ੕ভ
॥থঃॽड़থ঑‫ॸش‬ॕথॢभঁথॻ
॔क़ॺ‫ق‬3') ই॓ॖঝ‫॑ك‬ઉம਄ॉ੢िऒधऋदऌऽघ‫؝‬എযఐ୰৶৾ভ‫ق‬ৱમঌ‫ش‬४‫ك‬૚ர൥౰ঁথॻ॔क़ॺ‫ق‬ૌுभ॥থ
ঃॽड़থ঑‫ॸش‬ॕথॢभঁথॻ॔क़
ॺ॑அाऽघ‫ك‬ऋॲक़থট‫ॻش‬૭ચ
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ਸ਼  ৚঩মഎযఐ୰৶৾ভ৾୒ૐভ
৫ಈभओቂቇ ਸ਼  ৚঩মഎযఐ୰৶৾ভ৾୒ૐভ‫ق‬ভৃ‫ؠ‬পଚਿৈႣ৘‫ؚ‬ఎึভ่૧ஃਓ௧୅৾ૅ‫ك‬॑उ਼ਵऔचथःञटऎऒधधऩॉऽखञ‫؛‬ম৾ভभ৐ମदुँॉऽघਸ਼  ৚उेलਸ਼ ৚എযఐ୰৶ଢ଼஢ভ॑ௗಛୢఐপ৾दउ਼ਵऔचथःञटऌऽखञऋ‫ؚ‬০৚मਸ਼  ৚भম৾ভ৾୒ૐভশ॑णधीैोञুਣಇ঳੔েपਢःथ৘র୰੹भ୰৶ୢऋ૿ਊऔचथःञ
टऌऽघ‫؛‬खऊखఎึভ૸௩୰੹ऋ‫ؚ‬মফ  া  ঩पৗണ୎ૡ৫঵॑ඓइथउॉऽघঢ়બ
द‫ؚ‬ఎึভॢঝ‫ش‬উभ঱੶઱ਝ॑ভৃधऔचथःञटऌऽखञ‫؛‬ ০৚म‫ؚ‬ম৾ভभ௱ਗ૿ਊ৶হ॑णधीैोथउॉ‫ؚ‬ऽञ  া  ঩ऊै  ঩৑भ੒৒द
ിম৘पउःथਸ਼  ৚঩মഎযఐᇯᯂ৾ভ৾୒൥౰ভ॑৫ಈऔोॊിমপ৾भൺ᩽ೢඤઇ
౸प‫ؚ‬26( ध 67,& भ৑दณोॊຼ༰ቅध਻खथ્શ൥౰॑उൢःखथउॉऽघ‫؛‬ऽञઇ୘൥౰धखथ‫ؚ‬০৚भ਌਻दँॊ‫ؚ‬৕૝⅑৖၌஑འัਙቅधजभঢ়৴୰૗पणःथ‫ؚ‬:+2 ੌ௶ীథृऽुऩऎ৅໷औोॊ৕૝⅑ቅ਄ඞःૠ৺‫ؚ‬୰৶ౣਸ਼  ගभౣૐप๳
ৡऔो‫ؚ‬ऒभী৙भਸ਼঳য঻दँॊിমপ৾भਕ঱໙ಜઇ౸पउൢः॑ःञखऽखञ‫؛‬औैप০৚भ৾୒ૐভमఎึভॢঝ‫ش‬উਓഎযఐ൥౰ভ‫়؞‬৊ढ़থই॓ছথ५धभુಈधऔ
चथःञटऌ‫૸ؚ‬௩୰੹ଣೝ଍ఐभ৐িາ௟৖শपଣೝ଍൧૵ୢभয়ৃऊैुओ൥౰॑ः
ञटऌऽघ‫؛‬ ৎ౜ु෭ංधःअऒधद‫ؚ‬उଠਞुਞपऩॉऽघऋ‫ؚ‬যਞ௴୾৉਎੃षुඹ੺෱௞दघ
भद‫ؚ‬੗ਯभओ૞ਸ॑उୄठखथउॉऽघ‫؛‬ ਈ৏पম৾୒ૐভभ৫ಈपँञॉ‫ؚ‬ఎึভ১যম৖धॉॎऐ੕ਜ৖उेल৾୒৖प੗প
भओ੍ର॑ःञटःथउॉऽघऒधप஥පணखँऑऽघ‫؛‬ఎึভ ૸௩୰੹ ୰৶൧૵ఐ
੡্৳୏
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ਸ਼  ৚঩মഎযఐ୰৶৾ভ৫ಈ໪ਏ
঩ৎ  ফ‫ق‬਴ਛ  ফ‫ ك‬া  ঩‫ق‬ଅ໫঩‫ك‬ভৃ ఎึভ่૧ஃਓ௧୅৾ૅ ॼॖॳথ।‫ش‬ঝ঍‫ش‬ঝ‫ق‬পଚਿৈႣ৘‫ك‬ਈఞക -5 ূਲ੊଍ ৈႣ‫ق‬ञऊणऌ‫ك‬കৣ੤ െన‫ڱ‬ী     -5 ৈႣകषम‫ؚ‬     ৗୌ଍ৗপଚകৣ੤ ਎੃্એৗ඿சਗ਼੤৺  ী     ৗୌ଍਎੃കৣ੤ পଚ্એৗ඿சਗ਼੤৺  ী     ‫ق‬ःङोु೿੤കम‫ڭ‬കदघ‫ك‬਌਻ ৕૝᎒৖၌஑འัਙቅधजभঢ়৴୰૗
૞ਸા  ৞‫ق‬໤୫ఉਊ॑அि‫ك‬উটॢছ঒ ਭહ fྰਫ਼॥‫ شॼش‬f

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০৚भ਌਻‫ق‬৕૝᎒৖၌஑Ꮳቅउेलजभঢ়৴୰૗‫ك‬पঢ়৴खञඪ୻उेलजभ౎भඪ୻
ुਭહऐऽघ‫؛‬౰਻੡‫ؚ‬৅਀౰঻੡उेलਚര‫ ؚ‬ஊਰ৔भ౰਻ਏ຺‫ق‬ඪ୻‫ؚ‬୰৶ਚৄ‫ؚ‬ਖ਻ਡऩन‫ؚ॑ك‬ড‫ॻش‬ই॓ॖঝपथৣ੶पও‫ش‬ঝ๣હदउଛॉऎटऔः‫؛‬౰਻ணख੢ा
ഁीજॉम  া  ঩‫ౌق‬໫঩‫ك‬दघ‫؛‬ਭહ৏‫୹ؚ‬༮৷भफ़ছ५ఏমपજॉলख௕॑๣इथ
ৣ੶કਚपഖଛ॑उൢःःञखऽघ‫؛‬ਊ঩मफ़ছ५ఏমभ୹༮‫ؚ‬ঃড‫ش‬এॖথॺपेॊඪ
୻઀ં॑उൢःःञखऽघ‫୒৾؛‬ૐভીവ৏‫ؚ‬ඪ୻ਫ਼ୈभ৔ઍपणःथ঩মഎযఐ୰৶৾
ভහ๟षभ෋ൿ॑उൢःघॊऒधऋँॉऽघ‫؛‬ணख੢ा‫؞‬ਖः়ॎच੔ ‫؟‬ఎึভ ૸௩୰੹ ୰৶൧૵ఐ ੡্‫ق‬ऩऊञ‫ك‬৳୏‫ ٿ‬পଚ৘ਧპਆયኧ 
7(/ ॲॖখঝॖথ 
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➨㻞㻝ᅇ᪥㡑ྎ፬ே⛉⑓⌮ྜྠ䜹䞁䝣䜯䝷䞁䝇ᮭ䛾㒔 ௝ྎ

䝔䞊䝬䠖⭡⭷⑓ኚ≉ูㅮ₇ Ύᕝ㈗Ꮚ ඛ⏕ᩍ⫱ㅮ₇ ୕ୖⰾ႐ ඛ⏕఍㛗 㛗἟ ᘅ௝ྎᕷ❧⑓㝔 ๪㝔㛗఍ᮇ 㻞㻜㻝㻣ᖺ㻝㻜᭶㻞㻤᪥䠄ᅵ䠅㻝㻟䠖㻜㻜ࠥ㻝㻤䠖㻟㻜఍ሙ ௝ྎᕷ❧⑓㝔 ㅮᇽ
఍㈝䠗㻝㻜㻘㻜㻜㻜෇
₇㢟Ⓩ㘓➼ヲ⣽䛿ୗグ䝩䞊䝮䝨䞊䝆䜢ᚚぴୗ䛥䛔䚹஦ົᒁ䠗௝ྎᕷ❧⑓㝔⑓⌮デ᩿⛉ 㛗἟ ᘅ㻥㻤㻞㻙㻤㻡㻜㻞 ௝ྎᕷኴⓑ༊䛒䛩䛸㛗⏫㻝㻙㻝㻙㻝ヲ⣽䛿᪥ᮏ፬ே⛉⑓⌮Ꮫ఍㻴㻼䛻䛶㼔㼠㼠㼜㻦㻛㻛㼖㼟㼓㼥㼜㻚㼛㼞㼓㻛㼙㼑㼑㼠㼕㼚㼓㻚㼜㼔㼜㻠㻡

7 ᭶ 27 ᪥㸦ᮌ㸧
10:30㸫12:30 Presidential Endeavor: Robert Scully's Memorial Lectureᗙ㛗㸸⸨஭ ಙ࿃㸦ி㒔኱Ꮫྡ㄃ᩍᤵ㸧
Steven Silverberg㸦Professor Emeritus of Pathology, University of Maryland㸧
₇⪅㸸Esther Oliva㸦Department of Pathology, Massachusetts General Hospital㸧
ࠕThe evolving landscape of sex cord stromal tumors of the ovaryࠖ
Kyu-Rae Kim㸦Department of Pathology, Asan Medical Center㸧ࠕDiagnosis of Tumors and Tumor-like Lesions of Intermediate Trophoblastic OriginࠖΎᕝ ㈗Ꮚ㸦ᮾிឿᜨ఍་⛉኱Ꮫ⑓⌮Ꮫㅮᗙ㸧
ࠕSelected topics on ovarian tumors: Small cell carcinoma, hypercalcemic type, Krukenberg tumor,
and tumors with functioning stromaࠖ7 ᭶ 28 ᪥㸦㔠㸧
8:00-8:50 ࣮ࣔࢽࣥࢢࢭ࣑ࢼ࣮Iᗙ㛗㸸Ύᕝ ㈗Ꮚ㸦ᮾிឿᜨ఍་⛉኱Ꮫ⑓⌮Ꮫㅮᗙ㸧
₇⪅㸸Esther Oliva㸦Department of Pathology, Massachusetts General Hospital㸧ࠕMesenchymal tumors of the uterus: What matters?ࠖ
9:55-11:55 ࢩ࣏ࣥࢪ࣒࢘ II Precancerous lesions of gynecologic cancers
ᗙ㛗㸸Esther Oliva㸦Department of Pathology, Massachusetts General Hospital㸧⸨஭ ከஂ☻㸦⸨⏣ಖ೺⾨⏕኱Ꮫ་Ꮫ㒊⏘⛉፬ே⛉Ꮫᩍᐊ㸧
₇⪅㸸Lora Hedrik Ellenson㸦Department of Pathology and Laboratory Medicine, Will Cornnell Medical College㸧
ࠕMolecular Genetics of Endometrial Carcinoma: The Past, Present and Futureࠖ୕ୖ ⰾ႐㸦⇃ᮏ኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔⑓⌮デ᩿⛉㸧ࠕSquamous Intraepithelial Lesion of the Cervix : Pathological Perspective on Clinical Issuesࠖ୕ୖ ᖿ⏨㸦ᮾᾏ኱Ꮫ་Ꮫ㒊ᑓ㛛デ⒪Ꮫ⣔⏘፬ே⛉㸧ࠕClinical Approach of Precancerous Lesion in Japan: Understanding of pathological and clinicalsignificance of CIN and SILࠖ኱▼ ၿ୔㸦஑ᕞ኱Ꮫᙧែᶵ⬟⑓⌮㸧ࠕPrecursor lesion of endometrioid carcinomaࠖ⏣௦ ᾈᚨ㸦⇃ᮏ኱Ꮫ኱Ꮫ㝔⏕࿨⛉Ꮫ◊✲㒊ẕᏊ┳ㆤᏛศ㔝㸧
ࠕEIN and SEIC Clinical approachࠖᰗ஭ ᗈஅ㸦ᒸᒣ኱Ꮫ⑓㝔⑓⌮デ᩿⛉㸧ࠕPrecursor of ovarian serous carcinoma: Pathological aspectࠖᒸᮏ ឡග㸦ᮾிឿᜨ఍་⛉኱Ꮫ⏘፬ே⛉Ꮫㅮᗙ㸧
ࠕThe clinical management of STICࠖ
16:45㸫18:15 ≉ู௻⏬Ϩ ⑓⌮་࡜⮫ᗋ་࡛ゎㄝࡍࡿ፬ே⛉⭘⒆ᗙ㛗㸸᳃㇂ ༟ஓ㸦ᕝᓮ་⛉኱Ꮫ⑓⌮Ꮫ 2㸧
 ⏣௦ ᾈᚨ㸦⇃ᮏ኱Ꮫ኱Ꮫ㝔⏕࿨⛉Ꮫ◊✲㒊ẕᏊ┳ㆤᏛศ㔝㸧₇⪅㸸㤿ሙ 㛗 㸦ி㒔኱Ꮫ኱Ꮫ㝔་Ꮫ◊✲⛉ჾᐁእ⛉Ꮫ፬ே⛉Ꮫ⏘⛉Ꮫ㸧ࠕᏊᐑ⫗⭘㸫⮫ᗋࠖྡ᪉ ಖኵ㸦♫఍་⒪ἲேឡோ఍༓⯪⑓㝔⑓⌮デ᩿⛉㸧 ࠕᏊᐑ⫗⭘ࡢ⑓⌮ࠖ㧘▼ Ύ⨾㸦⇃ᮏ኱Ꮫ኱Ꮫ㝔⏕࿨⛉Ꮫ◊✲㒊⏘⛉፬ே⛉Ꮫศ㔝㸧ࠕ⤧ẟ⒴ࡢ⮫ᗋീࠖబ⸨ ຬ୍㑻㸦ᐑᓮ኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔⑓⌮デ᩿⛉⑓⌮㒊㸧ࠕ⤧ẟ⒴ࡢ⑓⌮ീࠖ㰻⸨ ಇ❶㸦⊂❧⾜ᨻἲேᅜ❧⑓㝔ᶵᵓ஑ᕞࡀࢇࢭࣥࢱ࣮፬ே⛉㸧ࠕእ㝜⒴ࡢ⑓⌮࡜⮫ᗋ࣭⮫ᗋ⠍ࠖᑎᮏ ඾ᘯ㸦ᅄᅜࡀࢇࢭࣥࢱ࣮⑓⌮⛉㸧ࠕእ㝜⒴ࡢ⑓⌮࡜⮫ᗋ࣭⑓⌮⠍ࠖ7 ᭶ 29 ᪥㸦ᅵ㸧
8:30㸫11:00 ⑓⌮⑕౛᳨ウ఍
SessionϨᗙ㛗㸸㤿ሙ 㛗㸦ி㒔኱Ꮫ኱Ꮫ㝔་Ꮫ◊✲⛉ჾᐁእ⛉Ꮫ፬ே⛉Ꮫ⏘⛉Ꮫ㸧 Ჷ᪉ ဴ㸦ሜᕷ❧⑓㝔ᶵᵓሜᕷ❧⥲ྜ་⒪ࢭࣥࢱ࣮⑓⌮デ᩿⛉㸧⚾࡜፬ே⛉⑓⌮㸸๓⏣ ኱ᆅ㸦⛅⏣኱Ꮫ኱Ꮫ㝔་Ꮫ⣔◊✲⛉ჾᐁ⑓ែᏛㅮᗙ㸧ࠕ፬ே⛉⑓⌮࡬ࡢᛮ࠸ࠖ
Sessionϩᗙ㛗㸸ຍ౗ ᜏኖ㸦஑ᕞ኱Ꮫ኱Ꮫ㝔་Ꮫ◊✲㝔ಖ೺Ꮫ㒊㛛㸧 ༡ཱྀ ᪩ᬛᏊ㸦ி㒔኱Ꮫ་Ꮫ㒊㝃ᒓ⑓㝔⑓⌮デ᩿⛉㸧⚾࡜፬ே⛉⑓⌮㸸຾㒊 Ὀ⿱㸦୰ᅜປ⅏⑓㝔⏘፬ே⛉㸧
SessionϪᗙ㛗㸸㛵᰿ ṇᖾ㸦᪂₲኱Ꮫ኱Ꮫ㝔་ṑᏛ⥲ྜ◊✲⛉㸧 ᡭᓥ ఙ୍㸦•༡㙊಴⥲ྜ⑓㝔⑓⌮デ᩿㒊㸧⚾࡜፬ே⛉⑓⌮㸸⸝ᮏ ༤⾜㸦㸦㈈㸧⚄ዉᕝ┴ண㜵་Ꮫ༠఍፬ே᳨デ㒊㸧㻢঩ম୰৶৾ভ੕ভ
঩মഎযఐ୰৶৾ভ॥থঃॽड़থ‫؞‬঑‫ॸش‬ॕথॢফা঩ ਎௝উছ२঍ॸঝ

෗ೕ‫؞‬໅ᒷ৔୰૗भ୰৶൧૵
ਕ঱໙ಜിমপ৾ୢ৾৖ဟര୰੹ ୰৶৖‫؞‬୰৶൧૵ఐ

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ວຼଵ

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Skinnider BF, et al.
Am J Surg Pathol 2004; 28: 77-83㻤ৈী৲஑໚୍૾রຜᇯ

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ϭϱϭϲn໅Ⴭਉ৅|‫ؚ‬nຼ༰ਉ৅|᪺ัਙቅम
ຼଵ፹ऋ৅েಟ৉दँॊ

໅Ⴭቅभ൧૵੦૆z ૏ડຼ༰भপऌऔऋਫଞ‫ँؚ‬ॊःमଐਙ૗
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STIC = Serous tubal carcinoma insitu䠄₢ᾮᛶ༸⟶ୖ⓶ෆ⒴䠅
Invasion ຼ༰भ୰༰ऩख ᇯᯂऋோ૔खथःथु਀ಽभापோ૔ख‫ؚ‬৑ସ࿠ဋऋाैोऩः ຜସ৑ସप࿠ဋखथःॊऋ‫[ؚ‬PP౞௥De novo
pathway

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Precursor(borderline)
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Surface or invasive ca.

ϭϳCarcinoma

Kindelberger et al, Am J Surg Pathol 2007;31:161-9
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༇ඪਙ൙଍೐࿈಍ཝᇯᯂ
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जभ౎
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༧য়ਙ଍೐ਙᇯᯂ
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ഷଵ෿ᇯథ঱ຜഷଵ৔ຜᇯ
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z ౮஑भங২‫ق‬ೄ২‫ؚ‬রಉ২‫ؚ‬ৈ২‫ك‬Pai RK et al. Am J Surg Pathol 2009; 33: 1425-1439

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᷀ᇯඪ *OLRPDWRVLVକ౺Ferguson AW, Katabuchi H, Ronnett BM, Cho KR.
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➨㻝㻜㻢ᅇ᪥ᮏ⑓⌮Ꮫ఍⥲఍᪥ᮏ፬ே⛉⑓⌮Ꮫ఍䝁䞁䝟䝙䜸䞁䝭䞊䝔䜱䞁䜾㻞㻜㻝㻣ᖺ㻠᭶㻞㻤᪥ ᪂ᐟ┠ḟ
1. ᝏᛶ୰⓶⭘䛾ᴫせዪᛶ䛾⭡⭷ᝏᛶ୰⓶⭘䛸䛭䛾㚷ูデ᩿
Malignant mesothelioma in female peritoneumand its differential diagnosis

2. ⎔ቃ┬▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ
3. ዪᛶ⭡⭷ᝏᛶ୰⓶⭘䛾≉ᚩ

Ύᕝ㈗Ꮚ

4. ዪᛶ⭡⭷୰⓶⭘䛾㚷ูデ᩿ᮾிឿᜨ఍་⛉኱Ꮫ ⑓⌮Ꮫㅮᗙ䞉ྠ㝃ᒓ⑓㝔 ⑓㝔⑓⌮㒊
12ᝏᛶ୰⓶⭘䛾ணᝏᛶ୰⓶⭘䛾ᴫせ• 䜎䜜 7ே/ேཱྀ100୓ே• ᪥ᮏ䛷䛾Ṛஸ⪅ᩘ䛿ቑຍ䠖䛣䛾20ᖺ㛫䛷3ಸ

⡿ᅜ
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3⎔ቃ┬▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘⓎ⑕ᩘ䠄/ேཱྀ100
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௒ᚋ40ᖺ ㈝⏝ (10㛫䛾Ṛஸ ൨䝗䝹)
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15

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250,000

80

7

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103,000

-

40

2015

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Robinson BW, Lake RA. Advances in malignant mesothelioma. N Engl J
4Med. 2005;353:1591-1603.

▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ▼⥥䛻䜘䜛೺ᗣ⿕ᐖ䛾ᩆ῭䛻㛵䛩䜛ἲᚊ(ᖹᡂ18ᖺἲᚊ➨4ྕ䠅Ø ▼⥥䠄䜰䝇䝧䝇䝖䠅䛻䜘䜛೺ᗣ⿕ᐖ䜢ཷ䛡䛯⪅䛺䛔䛧䛭䛾㑇᪘䛷䠈ປ⅏⿵ൾไᗘ➼䛾ᑐ㇟䛸䛺䜙䛺䛔⪅䛻ᑐ䛧䛶ᩆ῭⤥௜䛾ᨭ⤥䜢⾜䛖ປ⅏᫬ຠ䠖⿕⅏ປാ⪅䛾Ṛᚋ5ᖺ䛜⤒㐣ປ⅏ᑐ㇟እ䠖ᕤሙ࿘㎶䛾ఫẸ䛺䛹䠄⊂䠅⎔ቃ෌⏕ಖ඲ᶵᵓ䛂▼⥥䛸೺ᗣ⿕ᐖ䛃䜘䜚5㻞㻟⎔ቃ┬▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ⎔ቃ┬▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ• ୰⓶⭘䛾デ᩿䛾☜䛛䜙䛧䛥䛜ᢸಖ䛥䜜䜜䜀䠈▼⥥䜢྾ධ䛩䜛䛣䛸䛻䜘䜚Ⓨ⑕䛧䛯䜒䛾䛸ุᐃ䛩䜛Ø ᣦᐃ⑌⑓䠖• ୰⓶⭘⑓⌮⤌⧊Ꮫⓗ☜ᐃデ᩿䛜䛺䛥䜜䜛䛣䛸䛜㔜せ䠄⤌⧊ᶆᮏ䛜ᥦฟ䛥䜜䜛䛣䛸䛜ᮃ䜎䛧䛔䠅• ▼⥥䛻䜘䜛⫵䛜䜣• ⴭ䛧䛔࿧྾ᶵ⬟㞀ᐖ䜢క䛖▼⥥⫵• ⴭ䛧䛔࿧྾ᶵ⬟㞀ᐖ䜢క䛖䜃䜎䜣ᛶ⬚⭷⫧ཌØ ་Ꮫⓗุᐃ䠖⎔ቃ┬୰ኸᑂ㆟఍ෆ䛾ศ⛉఍㻔⑓⌮་㻞ྡ䠇ᨺᑕ⥺⛉་㻞ྡ䠇⮫ᗋ་䠅䜢⤒䛶ᑠጤဨ఍䛷ุᐃ• ἲ᪋⾜᪥䠄2006/3/27䠅๓䛻䛩䛷䛻Ṛஸ䛧䛯ሙྜ
䠄2022/3/27䜎䛷䠅ᕷ༊⏫ᮧ㛗䛻ᥦฟ䛧䛯Ṛஸデ᩿᭩䛻䠈Ṛஸ䛾ཎᅉ䛸䛧䛶䛂୰⓶⭘䛃䛾グ㍕䛜䛒䜛⪅䛜ᑐ㇟

78⭡⭷ᝏᛶ୰⓶⭘䛾≉ᚩ⭡⭷ᝏᛶ୰⓶⭘䛾๭ྜ• ୰⓶⭘䛾10䠂• ⏨ዪẚ ⏨ᛶ䠖ዪᛶ
7:3 (᪥ᮏ୰⓶⭘Ⓩ㘓)
1.5:1 (Hillerdal G. Br J Dis Chest. 1983;77:321-343.)• Meta analysis (4710౛): 10%⬚⭷89%, ᚰ⭷0.7%, ⢭ᕢ㠧⭷0.2%• 㧗⃰ᗘ䛾▼⥥ᭀ㟢䛿⭡⭷୰⓶⭘䛾༴㝤ᅉᏊ㧗⃰ᗘ᭚㟢䛷⭡⭷୰⓶⭘䛜Ⓨ⏕▷ᮇ㛫䛾᭚㟢䛷⬚⭷୰⓶⭘䛜Ⓨ⏕• ᪥ᮏ䛾୰⓶⭘Ⓩ㘓 (2013-2014): 7.2%⬚⭷90.3%䠈䛭䛾௚2.5%⎔ቃ┬ ▼⥥೺ᗣ⿕ᐖᑐ⟇ᐊ

Hillerdal G. Br J Dis Chest. 1983; 77:321-343.

Antman KH. Chest. 1993;103:373S-376S.

https://www.env.go.jp/air/asbestos/registration/• ༙ᩘ䛾⑕౛䛿▼⥥᭚㟢䛜☜ㄆ䛷䛝䛺䛔• ᪥ᮏ䠄๗᳨㍴ሗ䠅(1958-1996): 24.1%⬚⭷68.0%, ᚰ⭷6.1%, ⢭ᕢ㠧⭷0.3%,䛭䛾௚1.6%

Busch JM, et al. Radiographics 2002;22:1511-1515.

Murai Y. Arch Environ Health. 2001; 56:84-88.

• ▼⥥᭚㟢䛛䜙Ⓨ⑕䜎䛷䛿20-30ᖺ (⬚⭷䛿30-40ᖺ)
910⎔ቃ┬୰⓶⭘Ⓩ㘓බ⾲䝕䞊䝍ዪᛶ䛾⭡⭷ᝏᛶ୰⓶⭘2013-2015䠈ィ964౛䠈䛖䛱⭡⭷68౛䠄7%䠅

⏨ (769)⭡⭷5.5%

75⑕౛䛾᳨ウዪ (195)⭡⭷13.3%lᖺ㱋䠖17ṓ䠉92ṓ䠄ᖹᆒ47.4ṓ䠅l⑕≧䠖⭡③䠈⭡㒊⭾‶ឤl䜋䛸䜣䛹䛜ୖ⓶ᆺ⟶≧䠈ங㢌≧䠈䛣䜜䜙䛾ΰᅾ䇾㧗ศ໬ங㢌≧୰⓶⭘䇿䛻㢮ఝ䛧䛯ീ䛜୍㒊䛻䛒⬚⭷ 93.2%l㧗ᗘ᰾␗ᆺ䜢♧䛩䜒䛾䛿䜎䜜

Baker PM, et al. Am J Clin Pathol. 2005;123:724-737.
⎔ቃ┬ ▼⥥೺ᗣ⿕ᐖᑐ⟇ᐊ㼔㼠㼠㼜㼟㻦㻛㻛㼣㼣㼣㻚㼑㼚㼢㻚㼓㼛㻚㼖㼜㻛㼍㼕㼞㻛㼍㼟㼎㼑㼟㼠㼛㼟㻛㼞㼑㼓㼕㼟㼠㼞㼍㼠㼕㼛㼚㻛

11

12

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⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒ–ዪᛶ⭡⭷୰⓶⭘䛻㛵䛩䜛ゎᯒ⤖ᯝ–⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒ–ዪᛶ⭡⭷୰⓶⭘䛻㛵䛩䜛ゎᯒ⤖ᯝ–᳨ウጤဨ
බ⾗⾨⏕䠖᳃Ọㅬ஧⮫ᗋ䠖୕ᾆ⁅ኴ㑻䠈✄℩┤ᙪ⑓⌮䠖஭ෆᗣ㍤䠈ᒸ㍤᫂䠈Ύᕝ㈗Ꮚ䠈ᘅᓥ೺୕ᨺᑕ⥺䠖㓇஭ᩥ࿴䠈ᰩཎὈஅ
ᖹᡂ19ᖺᗘ⎔ቃ┬ㄳ㈇ᴗົ䠊ᖹᡂ19ᖺᗘ⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒཬ䜃䜀䛟㟢≧ἣㄪᰝᴗົሗ࿌᭩䠖་Ꮫⓗᡤぢ➼䛾ゎᯒㄪᰝ⦅. ᮾி䠖⊂❧ἲே⎔ቃ෌⏕ಖ඲ᶵᵓ;2008䠖15-23.

ᑐ㇟ዪᛶ⭡⭷୰⓶⭘16౛䠄ᮏே/㑇᪘䛾ᢎㅙ䛒䜚䠅
5౛䛿ᶆᮏ䛾෌᳨㙾୙ྍ⬟䛷᭩㢮䛛䜙ุ᩿• ▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ࡟⏦ㄳࡋ⭡⭷୰⓶⭘䛸䛧䛶ㄆᐃ䛥䜜䛯⑕౛䠄2006ᖺ3᭶䛛䜙2007ᖺ12᭶䠅ィ998౛䠖ዪ 250౛(25%)䠗⏨ 748౛ (75%)• ዪᛶ⭡⭷୰⓶⭘䠖27౛(10%)ᡃ䛜ᅜ䛾Ṛஸ⤫ィ (1995-2006)䛷ዪᛶ䛾⭡⭷୰⓶⭘䠚30%

13⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒ–ዪᛶ⭡⭷୰⓶⭘䛻㛵䛩䜛ゎᯒ⤖ᯝ–⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒ–ዪᛶ⭡⭷୰⓶⭘䛻㛵䛩䜛ゎᯒ⤖ᯝ–• ᖺ㱋䠖28-71ṓ䠄ᖹᆒ57ṓ䠅• ከⓎᛶ14 (88%); Ꮩ❧ᛶ 2 (12%䠖)• ほᐹᮇ㛫䠖5-80䞄᭶• ⭘⒗䛾኱䛝䛥: 3mm-ᕧ኱; <2cm 6౛• ⏕Ꮡ13౛䠈Ṛஸ3౛

• ⤌⧊ளᆺ䠖ୖ⓶ᆺ 12 (75%)䠗⫗⭘ᆺ 2 (12%)䠗஧┦ᆺ 1 (6%)䠗 ୙᫂ 1 (6%)

• Ⓨぢືᶵ䠖⭡③䠑䠈⭡㒊⭾‶ឤ䠐䠈Ⓨ⇕䠎䝗䝑䜾䛷⭘⒗1䠈᳨デ䛷⬚Ỉ1 䠈അ↛2䠄኱⭠⒴䠈༸ᕢወᙧ⭘䛷㛤⭡᫬䠅• ᰾␗ᆺ䠈᰾ศ⿣ീ䠈ቯṚ䛜┠❧䛯䛺䛔౛䛜ከ䛔ቯṚ䛒䜚 1; ᰾ศ⿣ീ䛒䜚 3; 㧗ᗘ᰾␗ᆺ 3䠆䠆᰾␗ᆺ䛿௨ୗ䛾ᇶ‽䛷3ẁ㝵ศ㢮Goldblum J, et al. Am J Surg Pathol. 1995;19:1124-1137.

• ⭡Ỉ, ⭘⒗䜢ዎᶵ䛻⭡⭍㙾䛒䜛䛔䛿㛤⭡⏕᳨䛒䜛䛔䛿௚⑌ᝈ䛻䜘䜚㛤⭡ᡭ⾡䛷デ᩿
1516⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒ–ዪᛶ⭡⭷୰⓶⭘䛻㛵䛩䜛ゎᯒ⤖ᯝ–• ᪩ᮇ䠖⭡⭷䛻2cm௨ୗ䛾䝫䝸䞊䝥≧⤖⠇䛜ከⓎ䛧䠈⬡⫫⤌⧊䛻ᾐ₶• 㐍⾜䠖ᡭᣙ኱䠈⭠⟶䜔༸⟶䛸୍ሢ䛻䛺䜚኱⥙඲య䜢༨䜑䜛ங㢌≧䠄⑕౛19103䠅

⟶≧䠄⑕౛19115䠅

඘ᐇᛶ䠄⑕౛19113䠅

ᚤᑠᄞ⬊ᵝ䠄⑕౛19109䠅

ᖹᡂ19ᖺᗘ⎔ቃ┬ㄳ㈇ᴗົ䠊ᖹᡂ19ᖺᗘ⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒཬ䜃䜀䛟㟢≧ἣㄪᰝᴗົሗ࿌᭩䠖་Ꮫⓗᡤぢ➼䛾ゎᯒㄪᰝ⦅. ᮾி䠖⊂❧ἲே⎔ቃ෌⏕ಖ඲ᶵ
ᵓ;2008䠖15-23.

17

㻞㻡

18

๓8ᯛ䛾෗┿䛿䠈ᮾிዪᏊ་⛉኱Ꮫඵ༓௦
་⒪䝉䞁䝍䞊⑓⌮デ᩿⛉ᘅᓥ೺୕ᩍᤵ䛾䛤ཌព䛻䜘䜛ங㢌≧䠄⑕౛19111 䠅ங㢌≧䠄⑕౛19111䠅

ᖹᡂ19ᖺᗘ⎔ቃ┬ㄳ㈇ᴗົ䠊ᖹᡂ19ᖺᗘ⿕ㄆᐃ⪅䛻㛵䛩䜛་Ꮫⓗᡤぢ➼䛾ゎᯒཬ䜃䜀䛟㟢≧ἣㄪᰝᴗົሗ࿌᭩䠖་Ꮫⓗᡤぢ➼䛾ゎᯒㄪᰝ⦅. ᮾி䠖⊂❧ἲே⎔ቃ෌⏕ಖ඲ᶵ
ᵓ;2008䠖15-23.

඘ᐇᛶ䠄⑕౛1910䠓䠅⫗⭘ᵝ䠄⑕౛19107䠅

19

20

Life
Expectancy in
Pleural andPeritoneal
Mesothelioma

2000; 66:191-197.

ཌ⏕ປാ┬ேཱྀືែ⤫ィ(2003-2005):ᝏᛶ୰⓶⭘2742౛
382౛䛾⑓⌮ᶆᮏ䜢ධᡭ• ⑓⌮་䠏ྡ䠈⮫ᗋ་䠐ྡ䠈ᨺᑕ⥺デ᩿་䠍ྡ䛷䠈⮫ᗋ⑓⌮Ꮫⓗ䛻᳨ウ• ⏨ᛶ䛾⬚⭷୰⓶⭘䛷probable/definite䠖74.3%• ዪᛶ䛾⭡⭷୰⓶⭘䛷probable/definite䠖22.2%

Shavelle R, et
al. Lung cancer
international.
2017:2782590

2221ዪᛶ⭡⭷ᝏᛶ୰⓶⭘䛾⏦ㄳ䛸ㄆᐃዪᛶ⭡⭷ᝏᛶ୰⓶⭘䛾⏦ㄳ䛸ㄆᐃ

ᖹᡂ18ᖺ3᭶27᪥䡚 ᖹᡂ29ᖺ3᭶31᪥ุᐃ䠈⤌⧊ᶆᮏ䛾ᥦฟ䛒䜚䠈221ே

ᖹᡂ18ᖺ3᭶27᪥䡚 ᖹᡂ29ᖺ3᭶31᪥ุᐃ䠈⤌⧊ᶆᮏ䛾ᥦฟ䛒䜚䠈221ே䠄ே䠅ɧᛐ‫ܭ‬51 ே
䠄23%䠅

6ே
䠄3%䠅

70

ㄆᐃ

60
50

164 ே
䠄74%䠅

୙ㄆᐃ

40

䛭䛾௚
୙ㄆᐃ

30

䛭䛾௚

20

ㄆᐃ

10
0

䠄ṓ䠅

㻞㻢

ᖺ㱋ู୙ㄆᐃ䛾⌮⏤䠄㻡㻝ே䠅୙ㄆᐃ䛾⌮⏤䠄51ே䠅ᖹᡂ18ᖺ3᭶27᪥䡚 ᖹᡂ29ᖺ3᭶31᪥ุᐃ䠈⤌⧊ᶆᮏ䛾ᥦฟ䛒䜚

ᖹᡂ18ᖺ3᭶27᪥䡚 ᖹᡂ29ᖺ3᭶31᪥ุᐃ䠈⤌⧊ᶆᮏ䛾ᥦฟ䛒䜚

5ே
䠄10%䠅

20
፬ே⛉⒴

፬ே⛉⒴
31ே
䠄61%䠅

15ே
䠄29%䠅

፬ே⛉௨እ
䛾⒴
ᝏᛶ䛸䛔䛘
䛺䛔

䠄ே䠅

ᝏᛶ䛸䛔䛘
䛺䛔

15

፬ே⛉௨
እ䛾⒴

10
5

፬ே⛉⒴

0

䠄ṓ䠅

ዪᛶ⭡⭷୰⓶⭘䛾⑓⌮デ᩿䛜㞴䛧䛔⌮⏤• ᝏᛶ୰⓶⭘䛾⤌⧊Ꮫⓗከᙬᛶ→㚷ู⑌ᝈ䛜ከ䛔ୖ⓶ᆺ䠄tubulopapillary, trabecular, micropapillary,solid, deciduoid, clear cell, pleomorphic)䠈஧┦ᆺ䠈⫗⭘ᆺ (desmoplastic)• ୖ⓶ᆺ䛜ከ䛔→⒴䛾⭡⭷᧛✀䞉㌿⛣䛸䛾㚷ู䜢せ䛩䜛• ༸ᕢ䛾₢ᾮᛶ⒴䞉ቃ⏺ᝏᛶ⭘⒆䠈᫂⣽⬊⒴䛿ୖ⓶ᆺ୰⓶⭘䛻㢮ఝ䛧䛯⤌⧊ീ䜢♧䛩䞉⭡⭷䛻ᗈ䛜䜛䛣䛸䛜䛒䜛ዪᛶ⭡⭷୰⓶⭘䛾⑓⌮デ᩿䛜㞴䛧䛔⌮⏤• ୰⓶⭘䛾ከ䛟䛿⣽⬊␗ᆺ䛜㍍ᗘ
• ཯ᛂᛶ୰⓶䛜⭡⭷䞉⬡⫫⤌⧊䛻ᾐ₶ᵝ䛾ീ䜢࿊䛩䜛䛣䛸䛜䛒䜛• ึデ᫬䛻፬ே⛉䜢ཷデ䛩䜛䛣䛸䛜ከ䛔• ፬ே⛉⭘⒆䛸䛧䛶㛤⭡ᡭ⾡䞉㛤⭡⏕᳨䛥䜜䜛౛䛜ከ䛔• ᨺᑕ⥺⏬ീ䛷䠈⒴䛾⭡⭷᧛✀䛸୰⓶⭘䛾㚷ู䛿㞴䛧䛔• ༸ᕢ⭘⒆䛻䛿ᝏᛶ୰⓶⭘䛸ඹ㏻䛧䛯ᙧ㉁䜢♧䛩䜒䛾䛜䛒䜛䠖₢ᾮᛶ⭘⒆ WT1+䠈䛸䛝䛻calretinin+ᡂேᆺ㢛⢏⭷⣽⬊⭘䛷䛿calretinin+27ච␿⤌⧊໬Ꮫ

28

ᝏᛶ୰⓶⭘デ᩿䛻䛚䛡䜛᭱㏆䛾ヰ㢟calretinin⭡⭷ᝏᛶ୰⓶⭘
+

⒴
-/+

WT 1
D2-40
BerEP4
MOC3++--/+ ⤌⧊ᆺ䛻䜘䜛
-/+
+
+

CEA

-

+/- ⤌⧊ᆺ䛻䜘䜛

PAX8

-

+/- ⤌⧊ᆺ䛻䜘䜛

Claudin 4

-

+

ER

-

+/-⤌⧊ᆺ䛻䜘䜛ᾘኻ䛾ሙྜ䛾䜏ព࿡䛒䜚䠄ᾘኻ䛧䛺䛔୰⓶⭘䜒䛒䜛䠅ୖ⓶ᆺ୰⓶⭘䠚஧┦ᛶ䠈⫗⭘ᆺ⭡⭷୰⓶⭘䛷䛿㢖ᗘ䛜ప䛔 䡚50%
䠎䠊p16䛾homozygousḞኻ (FISH)⭘⒆䛷䛒䜛䠈䛧䛛䛧୰⓶⭘䛸䛿㝈䜙䛺䛔⬚⭷୰⓶⭘䛷䛿⤌⧊ளᆺ䛻䛛䛛䜟䜙䛪㢖ᗘ䛜㧗䛔⭡⭷୰⓶⭘䛷䛿㢖ᗘ䛜ప䛔 䡚50%

PgR-+/-⤌⧊ᆺ䛻䜘䜛 29

Churg A, et al. Arch Pathol Lab Med. 2016;140:318-321.

䠍䠊BAP1Ⓨ⌧䛾ᾘኻ䠄ච␿⤌⧊໬Ꮫ䠅

BAP1㑇ఏᏊ䛾୧䜰䝺䝹䛻䛚䛡䜛ኚ␗䛸┦㛵ᐙ᪘ᛶ䛷䛿 germline-somatic㠀ᐙ᪘ᛶ䛷䛿 somatic-somatic㻞㻣30㧗ศ໬ங㢌≧୰⓶⭘ዪᛶ䛾⭡⭷ᝏᛶ୰⓶⭘䠖㚷ูデ᩿

Well-differentiated papillary mesotheliomaØ 㧗ศ໬ங㢌≧୰⓶⭘ Well-differentiatedpapillary mesothelioma (WDPM)• ዪᛶ䛾⭡⭷䛻ዲⓎ䛩䜛䜎䜜䛺୰⓶⣽⬊⭘⒆

Ø ⒴䛾㌿⛣䞉᧛✀• እྥᛶⓎ⫱䠈ቃ⏺᫂░䛺ங㢌≧⭘⒗• ணᚋⰋዲ

፬ே⛉㡿ᇦ䛾⒴• ༢Ⓨᛶ䠈ከⓎᛶ䛭䛾௚䛾⒴• ⤌⧊䠖ங㢌≧ᵓ㐀䠈㇏ᐩ䛺⥺⥔ᛶ㛫㉁ᾐ₶-/<0.䠑cm䠈⣽⬊␗ᆺஈ䛧䛔䠈᰾ศ⿣ീ䜎䜜Ø ፬ே⛉㡿ᇦ䛾⭘⒆䛾⭡⭷䜈䛾㐍ᒎ䞉෌Ⓨ• 㝈ᒁᛶᝏᛶ୰⓶⭘䛸䛿␗䛺䜛Ø ⭡⭷ཎⓎ⭘⒆Ø ୰⓶䛾཯ᛂᛶኚ໬

Daya D, et al. Cancer. 1990;65:292-296.
Malpica A, et al. Am J Surg Pathol .2012;36:117-127.
31

32㧗ศ໬ங㢌≧୰⓶⭘
Well-differentiated papillary mesothelioma㧗ศ໬ங㢌≧୰⓶⭘

26cases of WDPM
• ᖺ㱋23 -75 years (median, 47 y; mean, 48.6 y)• ▼⥥ᭀ㟢䛾᪤ 䛺䛧• ᪤ Ṕ: እ⛉ᡭ⾡ 10; Ꮚᐑෆ⭷⑕ 6• Ⓨぢືᶵ䠖௚⑌ᝈ䛾㛤⭡ᡭ⾡᫬䛻അ↛ 24;ᛴᛶ⭡⑕ 1; ៏ᛶⓗ䛺㦵┙③ 1• ከⓎᛶ 50%, 0.1-2cm• ୖ⓶ᆺᝏᛶ୰⓶⭘䛾㒊ศീ䛜WDPM䛻㢮ఝ䛩䜛䛣䛸䛜䛒䜛Ѝ඲యീ䜢䜏䛶ៅ㔜䛻デ᩿• ணᚋⰋዲ
33

Malpica A, et al. Am J Surg Pathol. 2012;36:117-127.

ᝏᛶ୰⓶⭘䛸㚷ู䜢せ䛩䜛፬ே⛉⭘⒆Ø ₢ᾮᛶ⒴༸ᕢ䠈⭡⭷䠈༸⟶Ꮚᐑෆ⭷䠈䠄Ꮚᐑ㢕㒊䠅༸ᕢ₢ᾮᛶ⒴l༸ᕢᝏᛶ⭘⒆䛾䛖䛱᭱䜒㢖ᗘ䛜㧗䛔l2䛴䛾⊂❧䛧䛯⤌⧊ᆺ䛜䛒䜛Ø ₢ᾮᛶቃ⏺ᝏᛶ⭘⒆༸ᕢ䠈༸ᕢ⾲ᅾᛶ䠈⭡⭷䜲䞁䝥䝷䞁䝖Ø ᫂⣽⬊⒴༸ᕢ䠈Ꮚᐑෆ⭷䠈Ꮚᐑ㢕㒊䠈⭡⭷㧗␗ᆺᗘ₢ᾮᛶ⒴(HGSC)

ప␗ᆺᗘ₢ᾮᛶ⒴(LGSC)

㐍⾜⒴㐍⾜⒴໬Ꮫ⒪ἲ ឤཷᛶ䛒䜚

ឤཷᛶప䛔

ᙧែ

Ø ⒴⫗⭘䠖Ꮚᐑෆ⭷䠈༸ᕢ䠈Ꮚᐑ㢕㒊䠈⭡⭷Ø ⭢⫗⭘䠖Ꮚᐑෆ⭷䠈༸ᕢ䠈Ꮚᐑ㢕㒊䠈⭡⭷35

34

ⴭ᫂䛺⣽⬊␗ᆺ䠈᰾ ᑠᆺᆒ୍⣽⬊䠈▼⅊ศ⿣ീ໬ⴭ᫂䠄㢖ᗘ䠈⛬ᗘ䠅Ⓨ⏕ᶵᗎ ᚑ᮶䛾༸ᕢ䞉⭡⭷ཎ ₢ᾮᛶቃ⏺ᝏᛶ⭘⒆Ⓨ⒴䛻䛿༸⟶ཎⓎ䛜
䛒䜛
36

㻞㻤

ᝏᛶ୰⓶⭘

㧗␗ᆺᗘ₢ᾮᛶ⒴ᝏᛶ୰⓶⭘ప␗ᆺᗘ₢ᾮᛶ⒴3738ච␿⤌⧊໬Ꮫ:⭡⭷ᝏᛶ୰⓶⭘䛸₢ᾮᛶ⒴Peritoneal epithelioid
mesothelioma (%)

Serous carcinoma
(%)

D2-40

37/40 ( 93)

6/45 ( 13)

Podoplanin

37/40 ( 93)

6/45 ( 13)

Calretinin

40/40 (100)14/45 ( 31)

Keratin 5/6

37/40 ( 93)

14/45 ( 31)

Thrombomodulin

29/40 ( 73)

2/45 ( 4)MOC-31
Ber-EP4

2/40 ( 5)5 /40 ( 13)44/45 ( 98)
45/45 (100)

CA 19-90/40 (0)30/45 ( 67)

CD15(Leu-M1)

0/40 (0)26/45 ( 58)

Ordonez NG. Mod Pathol. 2006;19:34-48.

39

Peritoneal
mesothelioma (%)

Serous carcinoma
(%)

WT1

22/24 (92)

18/20 (90)CEA

0/29 (0)7/20 (35)D2-40

22/23 (96)9/20 (45)Calretinin

29/29 (100)8/20 (40)

Thrombomodulin

21/22 (95)

1/20 ( 5)

MOC-31

1/19 (5)18/20 (90)

Ber-EP4

0/21 (0)20/20 (100)CA19-93/23 (13)16/20 (80)CD15(Leu-M1)

0/12 (0)12/20 (60)ER

0/15 (0)16/20 (80)

Takeshima Y, et al. Am J Clin Pathol. 2008;130:771-779. 40

ER

Pathol Oncol Res. 2009;15:671-678.

20 patients (14 males, 6 females)
cytoreductive surgery (CRS)
hyperthermic intraperitoneal chemotherapy (HIPEC)㝧ᛶ౛ ER 80% , PgR 100% , AR 65%
BerEP-4

MOC-3141

42

㻞㻥PAX 8, Claudin 4䛿₢ᾮᛶ⒴䛸䛾㚷ู䛻᭷⏝ච␿⤌⧊໬Ꮫ PAX 8
Laury

Ordonez NG. Modern Pathol.2013;26:553-562.

Peritoneal
mesothelioma (%)

Serous carcinoma (%)

2/23 (9)HGSC 151/152 (99)
LGSC 102/102 (100)Ordonez

0/40 (0)42/45 (93)PAX 8Claudin 4

Peritoneal
mesothelioma (%)

Serous carcinoma(%)

0/40 (0)0/40 (0)42/45 (93)44/45 (98)

Laury AR, et al. Am J Surg Pathol. 2010;34: 627-635.
Ordonez NG. Modern Pathol. 2013;26:553-562.
PAX 8paired-box family of transcription factor
development of kidney, thyroid, Wolffian ductorgan, Müllerian system, nervous system

PAX 8

43

Claudin 4
44₢ᾮᛶ⒴䠄༸ᕢ䠈⭡⭷䠅₢ᾮᛶቃ⏺ᝏᛶ⭘⒆䠄༸ᕢ䠈⭡⭷䠅䠘୰⓶⭘䛸䛾ඹ㏻Ⅼ䠚• ங㢌≧ᵓ㐀• LGSC䛷䛿␗ᆺ䛜㍍ᗘ䛷᰾ศ⿣ീ䛿ᑡ䛺䛔䠘୰⓶⭘䛸䛾㚷ูⅬ䠚• ⣽⬊䛾㔜ᒙ໬• HGSC䛷䛿䠈㧗ᗘ䛾⣽⬊␗ᆺ䠈᰾ศ⿣ീከ• ච␿⤌⧊໬Ꮫ
㝧ᛶ䠖MOC-31, Ber-EP4, Claudin 4, PAX8
ER-䜃䜎䜣ᛶᙉ㝧ᛶ䛾ሙྜ᭷⏝㝜ᛶ䠖calretinin, D2-40
WT-1, CEA䛿㚷ู䛻䛿ᙺ❧䛯䛺䛔
45䠘୰⓶⭘䛸䛾ඹ㏻Ⅼ䠚• ங㢌≧ᵓ㐀䠈ᗈ䛔㛫㉁• ᰾␗ᆺ䛿ᙅ䛔• ᰾ศ⿣ീ䛿ᑡ䛺䛔䠘୰⓶⭘䛸䛾㚷ูⅬ䠚• 㝵ᒙᛶ䛾䛒䜛ங㢌≧ᵓ㐀• ⭘⒆⣽⬊䛾㔜ᒙ໬䠈ศ㞳ቑṪ• ⥺ẟ䜢᭷䛩䜛⣽⬊䠇ዲ㓟ᛶ⣽⬊• ◁⢏య䠄୰⓶⭘䜘䜚㢖ᗘ䛜㧗䛔䠅• ⣽⬊デ䛷䛿⣽⬊㉁䛿䝺䞊䝇≧46༸ᕢ᫂⣽⬊⒴ Clear cell carcinoma
l
l
l

ᝏᛶ୰⓶⭘

₢ᾮᛶቃ⏺ᝏᛶ⭘⒆

l
l
l

l

ῐ᫂䛺⬊య᭷䛩䜛⭘⒆⣽⬊/䝩䝤䝛䜲䝹ᆺ⣽䜟䛜ᅜ䛷䛿༸ᕢୖ⓶ᛶᝏᛶ⭘⒆䛾24%༙ᩘ䛿䠥ᮇᚑ᮶䛾໬Ꮫ⒪ἲ䛻᢬ᢠᛶ⫗║ീ䠖ᄞ⬊ቨ䛾⤖⠇≧ ඘ᐇᛶᡂศ
⤌⧊ീ䠖ங㢌≧䠈⟶≧䠈඘ᐇᛶቑ⏕䠈⟶≧ᄞ⬊≧䠈ᚤᑠᄞ⬊≧䠈⣴≧䠈⥙≧ᵓ㐀䠈ῐ᫂䛺⣽⬊㉁䠈⣽⬊⭷᫂░䠈䝩䝤䝛䜲䝹䠊᰾␗ᆺ㧗ᗘ䠈᰾ศ⿣ീ䛿ẚ㍑ⓗᑡ䛺䛔Ꮚᐑෆ⭷⑕䛾ྜే 24% (5-38%)

47

48

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WT1, PAX8䛿᫂⣽⬊⒴䛸䛾㚷ู䛻᭷⏝᫂⣽⬊⒴䛸䛾㚷ู䛷ER-䛿୰⓶⭘䜢ྰᐃ䛷䛝䛺䛔

᫂⣽⬊⒴

ᝏᛶ୰⓶⭘

Clear cell carcinoma (%)

Serous carcinoma (%)

ER

30/237 (12.8)

151/200 (75.8)

WT䠍

6/237 (2.6)

159/200 (79.9)

Kobel M, et al. Am J Surg Pathol. 2009;33: 14-21.
Clear cell carcinoma (%)

Serous carcinoma (%)

16/16 (100)96/96 (100)PAX8Ozcan A, et al. Am J Surg Pathol. 2011;35: 1837-1847.
50

49ච␿⤌⧊໬Ꮫ᫂⣽⬊⒴䠄༸ᕢ䠈⭡⭷䠅⭡⭷ᝏᛶ୰⓶⭘⒴

calretinin

+

-/+

WT 1

+

₢ᾮᛶ⒴䠇᫂⣽⬊⒴-• ᰾ศ⿣ീ䛿ᑡ䛺䛔

D2-40
BerEP4+--/++• ⣽⬊㉁ෆglycogen

MOC3

-

+

䠘୰⓶⭘䛸䛾㚷ูⅬ䠚

CEA-+/- ⤌⧊ᆺ䛻䜘䜛• ᰾␗ᆺ䛜┠❧䛴PAX8-

Claudin 4-፬ே⛉ୖ⓶ᛶ⭘⒆䠇
䠄⢓ᾮᛶ⒴௨እ䠅
+

ER

-

₢ᾮᛶ⒴+

PgR

-

₢ᾮᛶ⒴+

䠘୰⓶⭘䛸䛾ඹ㏻Ⅼ䠚• ங㢌≧ᵓ㐀䠈㛫㉁䛾◪Ꮚ໬䠈• ⣽⬊䛾㔜ᒙ໬䛻ஈ䛧䛔• 䝩䝤䝛䜲䝹ᆺ⣽⬊(୰⓶⭘䛷䛿䜎䜜䠅• ⣽⬊⭷䛜᫂░• ච␿⤌⧊໬Ꮫ䠖WT-1㝜ᛶ, PAX8㝧ᛶ
5152⎔ቃ┬▼⥥೺ᗣ⿕ᐖᩆ῭ไᗘ䛻ዪᛶ⭡⭷䛾ᝏᛶ୰⓶⭘䜢⏦ㄳ䛩䜛㝿䛻䛿䠖⑓⌮ሗ࿌᭩䠇⤌⧊ᶆᮏ䠇ච␿⤌⧊໬Ꮫ
PAX 8 expression (%) BAP1 Expression (%)ୖ⓶ᆺᝏᛶ୰⓶⭘䜢⪃䛘䜛౛䠄⒴䛸䛾㚷ู䠅

Positive

Negative

RetainLost㝧ᛶ䝬䞊䜹䞊2✀㢮䠖Calretinin, WT1, D2-40

Malignant peritoneal
mesothelioma

4 (16)

21 (84)9 (36)

16 (64)㝜ᛶ䝬䞊䜹䞊2✀㢮䠖CEA, Ber-EP4, MOC-31

Well-diff papillary
mesothelioma

1 (10)

9 (90)

10

0

Benign multicystic
papillary mesothelioma

0

3

3

0

Mesothelial inclusion cyst

1

0

1

0

+ER, PgR⫗⭘ᆺᝏᛶ୰⓶⭘䛸⪃䛘䜙䜜䜛౛䠄⫗⭘䛸䛾㚷ู䠅㝧ᛶ䝬䞊䜹䞊䛸䛧䛶ୖ⓶ᛶ䝬䞊䜹䞊2✀㢮(CAM5.2, AE1/3䛺䛹)106th Annual Meeting, United States and Canadian Academy of Pathology,
San Antonio, TX., March 6, 2017. Mod Pathol. 2017; 30 (S2) :279A.
53

54

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༸ᕢ䛸⭡⭷ᝏᛶ୰⓶⭘ዪᛶ䛾⭡⭷୰⓶⭘䠖䜎䛸䜑 1/2• ༸ᕢ䛾ᝏᛶ୰⓶⭘ከ䛟䛿⭡⭷ཎⓎ䛾⭘⒆䛜༸ᕢ䛻㐍ᒎ䛧䛯䜒䛾䊻⑓ኚ䛾୺ᗙ䛿⭡⭷䠈༸ᕢ䛾⑓ኚ䛿୧ഃᛶØ 䜎䜜Ø ึ䜑䛻፬ே⛉ཷデ䛩䜛౛䛜ከ䛔Ø ⮫ᗋⓗ䛻፬ே⛉⭘⒆䜢␲䜟䜜䜛䛣䛸䛜⌋䛧䛟䛺䛔䜎䜜䛻༸ᕢཎⓎ䠄⑓ኚ䛜༸ᕢ䛻㝈ᒁ䠅• ⭡⭷䛻䜃䜎䜣ᛶ⑓ኚ䛒䜚䛾౛䛷䛿༸ᕢ䛻Ἴཬ(10/12)
Goldblum J, et al. Am J Surg Pathol. 1995;19:1124-37.

Ø ୖ⓶ᆺ䛜ከ䛔

Ѝ⒴䛾⭡⭷㌿⛣䞉᧛✀䛸䛾㚷ู䜢せ䛩䜛• ༸ᕢ䛾⫗║ᡤぢ䠖༸ᕢ⾲㠃䛾ከ⤖⠇ᛶ⑓ኚ䠈༸ᕢ䜢⿕ໟ䠈༸ᕢᐇ㉁䜢⨨᥮፬ே⛉㡿ᇦ䛾ୖ⓶ᛶ䞉ୖ⓶ᵝ⭘⒆䠄₢ᾮᛶ⒴䠈₢ᾮᛶቃ⏺ᝏᛶ⭘⒆䠈᫂⣽⬊⒴䠈௚䠅55

56ዪᛶ䛾⭡⭷୰⓶⭘䠖䜎䛸䜑 2/2

ㅰ㎡

Ø 㚷ู䛻ච␿⤌⧊໬Ꮫ䛾⤌䜏ྜ䜟䛫䛜᭷⏝㝜ᛶ䠖MOC-31, Ber-EP4, PAX8*, claudin 4
㝧ᛶ䠖D2-40, calretinin
ER-䜃䜎䜣ᛶᙉ㝧ᛶ䛺䜙୰⓶⭘䛿ྰᐃⓗER㝧ᛶ䠖₢ᾮᛶ⭢⒴-75.8%᫂⣽⬊⭢⒴-12.2%

௒ᅇ䛾Ⓨ⾲䛻䛒䛯䜚䠈䛤ᣦᑟ䛚䜘䜃䛤༠ຊ䛔䛯䛰䛝䜎䛧䛯ୗグ䛾ⓙᵝ䛻῝ㅰ⏦䛧ୖ䛢䜎䛩䠊୰ኸ⎔ቃᑂ㆟఍⎔ቃಖ೺㒊఍▼⥥೺ᗣ⿕ᐖุᐃᑠጤဨ఍ጤဨ㛗 ᓊᮏ༟ᕭ ඛ⏕ᑓ㛛ጤဨ ᘅᓥ೺୕ ඛ⏕Ø WT-1䛿᫂⣽⬊⒴䛸䛾㚷ู᫬䛻䛿᭷⏝୰⓶⭘䠈₢ᾮᛶ⒴䛷㝧ᛶ; ᫂⣽⬊⒴㝜ᛶ⎔ቃ┬⥲ྜ⎔ቃᨻ⟇ᒁ ⎔ቃಖ೺㒊⎔ቃಖ೺௻⏬⟶⌮ㄢ ▼⥥೺ᗣ⿕ᐖᑐ⟇ᐊ኱⚄ᣅ㑻 ᵝØ CEA㝧ᛶ䛷䛒䜜䜀୰⓶⭘䜢ྰᐃ䛷䛝䜛䛜䠈⭡⭷୰⓶⭘䛷䛿㚷ูデ᩿䛾᭷⏝ᛶ䛿ప䛔57

58

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