乳房外ページェット病の病理組織学的ならびに組織化学的研究 特にＰｅｒｉｏｄｉｃ Ａｃｉｄ Ｍｅｔｈｅｎａｍｉｎｅ‐Ｓｉｌｖｅｒ（ＰＡＭ）染色による検索

Abstract

The author investigated the origin of Paget's cells and the pathogenesis of the extramam-mary Paget's disease. Biopsied specimens of the skin from 22 patients suffering from the disease were subjected to a conventional light microscopic and electron microscopic investigation. Particular attention was paid to the staining property to the Periodic Acid Methenamine-Silver (PAM) stain in both light and electron microscopic sections.The following results were obtained :1) The HE stained sections disclosed large Paget's cells which showed abundant eosinophilic cytoplasm and small Paget's cells which showed scanty cytoplasm.2) These two types of Paget's cells were dispersed or aggregated in the epidermis, in the follicular spaces or deeper layer.3) The majority of Paget's cells were storongly positive in the Alcian Blue, PAS, Mucicarmine and PAM staining procedure. The intensity of the stainability was essentially identical in the four staining procedures in majority of cells. The result may indicate the localization of the mucopolysaccharide or glycoprotein in the cytoplasm of the cells. More importantly the result may reflect the possibility that the cells may possess an adenocytic feature.4) Based on the ultrastructural features of the secretory granules, vesiculation and intracytoplasmic organellae, Paget's cells are classified into secretory, vacuolar and non-secretory types. These cells contained very few intra-cytoplasmic fibrils, however, quite often they possessed small incomplete desmosomes. It is interesting to note that the cells possessed protruded microvilli in intercellular spaces and occasionally formed an adenoid configuration in an aggregated portion of the cells.5) The PAM impregnation technique disclosed strongly positive secretory granules in the cytoplasm which showed a rather large contour. This may strongly support a view that Paget's cells may possess the adenocytic nature and may be derived from a glandular structure.This study conclusively supports the glandular origin theory of Paget's cells.