腎腺癌の血管構築と病態の解釈

血管造影所見の解釈を中心に

抄録

The vascular architecture of four cases of renal adenocarcinoma was studied histologically and microangiographically and the architecture was revealed to differ from that of others.
Alveoli of cancer cells are covered with a layer of endothelium. The spaces between the alveoli make themselves complicated blood spaces rather than blood vessels and the spaces communicate with each other, i. e., a sinusoidal structure. Beneath the capsule, the sinusoids receive blood from capsular arteries and the sinusoids with the connective tissue between cancer cells and the endothelium drain to a vein, like in a central vein of the liver.
Such structure is nearly universal in every type of renal adenocarcinomas and it is oncogenetically interesting that the structure is sometimes seen in certain endocrine organs including the adrenal gland.
In such a structure cancer cells adjacent to the endothelium easily fall off to the blood space and spread by blood borne metastasis.
Angiographically the contrast media pools and/or stagnates in the complicated blood spaces (sinusoids) and results in findings of “pooling”, “puddling” etc. Expanded blood spaces caused, for example, by necrotic desquation result in “laking” or “a-v fistula”.