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<meta name="description" content="病理総論的な本態とその病態プロセスの理解なくして，病理診断は行えない―．非腫瘍性骨関節疾患の組織形態を読み解くためには，病態の時間経過を踏まえ，類推，検証していくプロセスが必須となる．本書では長年，骨関節の病理診断に携わってきた著者が，目の前にある標本の組織形態をいかに読み解くか，その診断思考プロセスを惜しげもなく披瀝する．2003年に刊行した『非腫瘍性骨関節疾患の病理』をベースに，日常の鑑別診断">

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		<h1 class="catchCopy">次世代に継承されるべき，唯一無二の必携書！</h1>
		

		<h1 class="copy">非腫瘍性疾患病理アトラス</h1>
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					著：石田　剛（独立行政法人国立病院機構埼玉病院病理診断科部長）
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					<span class="transparent">著</span>　今村哲夫（帝京短期大学ライフケア学科教授／帝京大学名誉教授）
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3><h3 class="review">書評</h3></div><section class="current content">病理総論的な本態とその病態プロセスの理解なくして，病理診断は行えない―．非腫瘍性骨関節疾患の組織形態を読み解くためには，病態の時間経過を踏まえ，類推，検証していくプロセスが必須となる．本書では長年，骨関節の病理診断に携わってきた著者が，目の前にある標本の組織形態をいかに読み解くか，その診断思考プロセスを惜しげもなく披瀝する．2003年に刊行した『非腫瘍性骨関節疾患の病理』をベースに，日常の鑑別診断でより参照しやすいように章立てを変更し，新たに200枚以上の精選した写真を追加した改訂復刊．</section><section class="preface">序<br><br>　本書の前身は，今からほぼ四半世紀前に今回と同じ著者により文光堂から出版された「非腫瘍性骨関節疾患の病理」であり，実質的にはその第2版である．「非腫瘍性骨関節疾患の病理」は当時としては類書がなかったことから，多くの病理医，病理検査室に迎えられたが，すでに絶版となって久しく，入手困難な状態が続いていた．電子書籍の形で復刊はしたものの，依然，紙の書籍の形での出版の要望が連綿とあったとも聞いている．これほどの長命を保ったことは日々進歩の著しいこのような分野の学術書ではたいへん珍しいことであり，また，著者にとって密やかな悦びであったのも事実である．この度，文光堂の「非腫瘍性疾患病理アトラス」シリーズに骨・関節が加わることになり，これを機に「非腫瘍性骨関節疾患の病理」を改訂し，本シリーズの1冊として新たな命をいただくことになった．<br>　基本的には初版を踏襲した内容であるが，今回の改訂では日常診断に際してより便利に参照しかつ使用できるように，鑑別診断を考慮して章立てを入れ替え，そしてアトラスとしての用途にも耐えるよう写真の追加も行った．また，初版では十分な記載のできなかった若干の疾患について追加した．初版出版時には非腫瘍性疾患として位置づけられていたLangerhans細胞組織球症，滑膜軟骨腫症や骨化性筋炎などのいくつかの疾患は近年の分子病理学的解析の進歩により腫瘍性性格が明らかにされ，腫瘍性疾患であると理解されようになったが，永年にわたり非腫瘍性疾患として扱われてきた病態そのものが変わったわけではないことから，今回の改訂でも取り上げることにした．文光堂から刊行されている「腫瘍病理鑑別疾患アトラス」シリーズの内容とも一部重複する点もあるかとは思うが，ご容赦願いたい．<br>　非常に大雑把な言い方が許されるなら，腫瘍性疾患の場合，その病理診断は腫瘍細胞を把握し分類するという存在論的アプローチが主となる．一方，非腫瘍性疾患では，その病理組織像を形成するに至った疾患の病理総論的な本態とその病態プロセスの理解なくして，病理診断は行えない．つまり，目の前にある標本の組織形態がどのように作り上げられてきたものなのか，時間的にはその瞬間の一断面でなく，継続的な時間経過を踏まえて類推，検証していくアブダクション的思考法がより必要となる．本書では，そのような思考プロセスを組織像の中からどう読み取るのか，読み取れるのか，についてもできるだけ記載したつもりである．是非，組織像の成り立ちを理解したうえで非腫瘍性疾患の病理診断につなげていただきたい．<br>　著者らが経験していないイタイイタイ病の項目は，獨協医科大学日光医療センター　山口岳彦先生に特別にお願いして書いていただいた．また，イタイイタイ病症例の病理組織写真の掲載について，富山大学学術研究部医学系病理診断学講座　平林健一先生には特段のご配慮を賜った．ここに改めて感謝申し上げます．これにより本書がよりいっそう網羅的でよいものになったものと考えている．<br>　今回もまた，コンサルテーションを通じて稀な疾患を経験させていただいた．症例をお送りいただき，また，快く本書での使用をご許可くださった先生方にはこの場を借りて厚く御礼申し上げます．<br>　改訂作業の最中，著者らの共通のmentorであるHoward D. Dorfman先生がご逝去された．これまでのDorfman先生のご指導に深く感謝し，ここに謹んでご冥福をお祈りいたします．<br>　生物学者のRichard Dawkinsは世界的にベストセラーとなった彼の代表的著書「利己的な遺伝子」のなかで，世代を超えて受け継がれるgene と同様，世代を超えて受け継がれていく考え，思考方法，文化などの無形物に対してgeneのアナロジーとしてmemeという概念を提唱した．心理学者のSusan Blackmoreはその考えに基づき，「meme machineとしての私」という考えを提唱している．そういう意味では著者らはDorfman先生のbone pathologyのmeme machineである，という言い方も可能であろう．とすれば，Dorfman先生の教えは本書の中にmemeとして確実に息づいていると信じたい．そして，もしそうであるならば，本書の読者の中からそのmemeを受け継ぐ次世代のbone pathologistが生まれてくることを切に願っている．<br>　今回の改訂作業はすべて石田が行った．したがって内容に関しての責任はすべて石田にある．ご指摘，ご批判を賜れば幸いである．最後に，本書の出版にあたり，企画段階から改訂作業，刊行まで文光堂の鈴木貴成，佐藤真二両氏には，大変お世話になりました．佐藤真二氏には本書の前身である「非腫瘍性骨関節疾患の病理」と「骨腫瘍の病理」そして今回と著者（石田）が関わった骨・関節領域のsurgical pathology book 3冊すべてにおいて大変お世話になりました．佐藤真二氏の長年にわたるサポートに対して改めて厚く御礼申し上げます．鈴木貴成氏には著者の遅々として進まない改訂作業を辛抱強く見守りかつ励ましていただき，また，著者のわがままとも言える細かな要望にも応えていただき，本書を出版まで的確に導いていただきましたこと，本当に感謝の念にたえません．どうもありがとうございました．<br><br>　2024年盛夏<br>　石田　剛</section><section class="indexes">第1章　イントロダクション<br>　Ⅰ　本書を繙く読者に<br>　Ⅱ　非腫瘍性骨関節疾患の一般的な参考書<br><br>第2章　変形性関節疾患<br>　Ⅰ　変形性関節症<br>　Ⅱ　二次性変形性関節症<br>　Ⅲ　大腿骨骨頭病変の鑑別診断のポイント<br><br>第3章　関節リウマチとその関連疾患<br>　Ⅰ　関節リウマチ<br>　Ⅱ　その他の膠原病<br>　Ⅲ　リウマトイド因子陰性脊椎関節炎<br><br>第4章　骨壊死<br>　Ⅰ　基本的事項<br>　Ⅱ　阻血性骨壊死<br>　Ⅲ　骨梗塞<br>　Ⅳ　離断性骨軟骨炎<br>　Ⅴ　骨軟骨症（骨端症） <br><br>第5章　非感染性滑膜・関節・関節腔の病変と関節の腫瘍・腫瘍様病変<br>　Ⅰ　破砕性滑膜炎<br>　Ⅱ　神経障害性関節症<br>　Ⅲ　急速破壊型股関節症（RDC）<br>　Ⅳ　軟骨下脆弱性骨折（SIF） <br>　Ⅴ　ヘモジデリン沈着性滑膜炎<br>　Ⅵ　関節遊離体<br>　Ⅶ　滑膜軟骨腫症<br>　Ⅷ　傍関節軟骨腫・関節包内軟骨腫<br>　Ⅸ　びまん型腱滑膜巨細胞腫（色素性絨毛結節性滑膜炎），腱鞘巨細胞腫 <br>　Ⅹ　滑膜脂肪腫（樹枝状脂肪腫） <br>　Ⅺ　滑膜血管腫<br>　Ⅻ　関節内結節性筋膜炎<br><br>第6章　結晶沈着症とその関連疾患<br>　Ⅰ　結晶の偏光観察<br>　Ⅱ　痛風<br>　Ⅲ　ピロリン酸カルシウム（CPPD）結晶沈着症<br>　Ⅳ　塩基性リン酸カルシウム結晶沈着症（カルシウムハイドロキシアパタイト結晶沈着症）<br>　Ⅴ　オキサローシス（シュウ酸症） <br>　Ⅵ　オクロノーシス <br>　Ⅶ　腫瘍状石灰沈着症<br>　Ⅷ　フォスフォグリセリド結晶沈着症<br><br>第7章　人工関節に関連する病変<br>　Ⅰ　はじめに<br>　Ⅱ　人工関節の構成<br>　Ⅲ　摩耗粉の同定と非感染性の人工関節の弛み<br>　Ⅳ　感染性人工関節の弛み<br>　Ⅴ　人工関節に合併する悪性腫瘍<br><br>第8章　膝関節の病変<br>　Ⅰ　膝関節の解剖<br>　Ⅱ　膝内障<br>　Ⅲ　半月板損傷<br>　Ⅳ　十字靱帯損傷<br>　Ⅴ　タナ障害<br>　Ⅵ　分裂膝蓋骨<br>　Ⅶ　膝蓋軟骨軟化症<br><br>第9章　脊柱の病変<br>　Ⅰ　脊柱の解剖<br>　Ⅱ　脊柱管狭窄症<br>　Ⅲ　椎間板ヘルニア<br>　Ⅳ　付着部と付着部炎・付着部症<br>　Ⅴ　脊柱靱帯骨化症，石灰化症<br>　Ⅵ　黄色靱帯偽囊胞変性症<br>　Ⅶ　脊柱靱帯アミロイドーシス<br>　Ⅷ　椎間関節の病変<br>　Ⅸ　その他の病変<br><br>第10章　滑液包・腱・靱帯の病変<br>　Ⅰ　滑液包，腱，靱帯の正常構造<br>　Ⅱ　滑液包の病変<br>　Ⅲ　腱・靱帯組織病変の基本像<br>　Ⅵ　de Quervain腱鞘滑膜炎<br>　Ⅶ　ばね指<br>　Ⅷ　Dupuytren拘縮<br>　Ⅸ　手根管症候群<br>　Ⅹ　足根管症候群<br>　Ⅺ　腱黄色腫<br>　Ⅻ　腱・靱帯の異所性骨化<br><br>第11章　骨系統疾患<br>　Ⅰ　骨系統疾患とは<br>　Ⅱ　タナトフォリック骨異形成症と軟骨無形成症<br>　Ⅲ　骨形成不全症<br>　Ⅳ　大理石骨病<br>　Ⅴ　濃化異骨症<br>　Ⅵ　メロレオストーシス<br>　Ⅶ　片肢性骨端異形成症<br>　Ⅷ　Caffey病<br><br>第12章　骨外傷・骨折<br>　Ⅰ　骨折の分類と用語<br>　Ⅱ　骨折の治癒過程<br>　Ⅲ　骨癒合と骨癒合不全<br>　Ⅳ　疲労骨折<br>　Ⅴ　脆弱性骨折<br>　Ⅵ　裂離骨折<br>　Ⅶ　大腿骨頸部骨折<br>　Ⅷ　外傷後骨溶解症<br>　Ⅳ　腱板損傷<br>　Ⅴ　石灰化腱炎<br><br>第13章　骨，関節の感染症<br>　Ⅰ　骨髄炎<br>　Ⅱ　感染性関節炎<br>　Ⅲ　SAPHO症候群とその関連疾患（慢性再発性多発性骨髄炎，胸肋鎖骨肥厚症，掌蹠膿疱症性骨関節炎）<br><br>第14章　代謝性骨疾患・代謝異常症<br>　Ⅰ　はじめに <br>　Ⅱ　骨代謝の基礎的事項<br>　Ⅲ　骨生検<br>　Ⅳ　骨粗鬆症<br>　Ⅴ　副甲状腺機能亢進症<br>　Ⅵ　骨軟化症・くる病<br>　Ⅶ　イタイイタイ病（カドミウム中毒症）<br>　Ⅷ　腎性骨異栄養症<br>　Ⅸ　透析アミロイドーシス <br>　Ⅹ　Paget病<br><br>第15章　その他の骨疾患<br>　Ⅰ　組織球性疾患<br>　Ⅱ　白質脳症を伴う脂肪膜性骨異栄養症（Nasu-Hakola病） <br>　Ⅲ　ライソゾーム病<br>　Ⅳ　骨膜疾患<br><br>第16章　骨化性筋炎とその関連疾患<br>　Ⅰ　はじめに<br>　Ⅱ　疾患概念と用語の問題<br>　Ⅲ　骨化性筋炎<br>　Ⅳ　指趾線維骨性偽腫瘍<br>　Ⅴ　骨化性筋膜炎<br>　Ⅵ　頭蓋骨筋膜炎<br>　Ⅶ　開花性反応性骨膜炎<br>　Ⅷ　傍骨性骨軟骨異形増生<br>　Ⅸ　爪下外骨腫<br>　Ⅹ　小塔状外骨腫<br><br>第17章　病理組織診断の表記法<br>　1　変形性関節疾患<br>　2　関節リウマチとその関連疾患<br>　3　骨壊死<br>　4　滑膜・関節腔の病変<br>　5　結晶沈着症<br>　6　人工関節に関連する病変<br>　7　膝関節の病変<br>　8　脊柱の病変<br>　9　滑液包・腱・靱帯の病変<br>　10　骨系統疾患<br>　11　骨外傷・骨折<br>　12　代謝性骨疾患<br><br>文　献<br>索　引</section><section class="review">評者：𠮷田朗彦（国立がん研究センター中央病院 病理診断科）<br><br>　石田 剛先生と今村哲夫先生の『非腫瘍性骨関節疾患の病理』が出版されたのは2003年のことである．何度も読み返して下線や書き込みでいっぱいになったその青い本は，いつも書棚の前列に置いてある．けれども長い間絶版になっていて，そのページを繰る楽しみを次の世代の人たちと共有できないのをどこか寂しく感じていた．それがこのたび，非腫瘍性疾患病理アトラスシリーズの「骨関節」として，21年ぶりに改訂復刊された．心から祝いたい．初版の良さはそのままに，テキストも図版も量を増し，付着部症，軟骨下脆弱性骨折，塩基性リン酸カルシウム結晶沈着症など，新たに詳しい説明が加わったのも嬉しい．<br>　この本を開いてすぐにわかるのは，その徹底した実用性である．この大腿骨頭のどっちが内側なのか．この結晶の種類はどうすればわかるのか．毎日の病理診断で，誰もがまず知りたいと思うことがまっすぐ書かれていて，どこから読み始めても役に立つ．軒のように張り出した骨棘やレール軌道のようなtunneling resorptionなど比喩もやさしい．ついやりがちな勘違いにも気配りがあって，変形性関節症の象牙質化は「一見面出しが不良で表面がでていないようにみえる」し，阻血性骨壊死のnecrotic debrisは「鋸屑組織と誤ってはならない」．巻末には診断文例集まで用意されている．まるで隣の席の親切な先輩から教わっているように，今日から使える生きた知識がするする入ってくるのである．<br>　注意深く選ばれた図版は見せたいものが明白で，なかでも目を見張るのは，放射線画像や肉眼・低倍写真の豊かさである．ともすれば高倍率に傾きがちな病理医に，著者らは2倍対物レンズの価値を説く．何でもむやみに拡大すればよいわけではなく，現象を把握するのに適したスケールというものがあるからだ．テキストは，単なる情報に陥ることなく，丁寧につづられた正確な文章が流れをなして迷うところがない．その理路に沿って読み進めていくうちに，複雑な病態でもその成り立ちが自然とわかってくるのである．そして窪み，亀裂，皺といったものすべてに名前がついていること，それらは偶然そこにあるのではなく，それぞれ意義を備えた所見としてあることが感得されると，何もないと思っていた視野が突然所見で溢れ出して驚かされる．<br>　それだけではない．力学的負荷と生体の反応に一定の規則性があるために，所見の中には順序のはっきり決定できるものもある．例えば，線維骨はその接する層板骨より後で作られたのだし，仮骨が形成されたのは骨折の後にほかならない．だから，所見そのものは動きのない形であっても，そこには時間の流れが少しずつ表現されていて，臨床経過や画像と組み合わせて推理を働かせれば，今の病状に至るまでに生起したイベントの長い連鎖を描き出すこともできるのである．序文で「アブダクション的思考法」とも呼ばれているこの遡及的な推論は，非腫瘍性骨関節病理学の大きな魅力として，本書の全編にわたっていきいきと躍動している．とりわけ大腿骨頭の軟骨下脆弱性骨折と阻血性骨壊死との鑑別において，修復性組織反応に注意しながら壊死の起こったタイミングを読み解いていくくだりなど，その醍醐味を伝えて余すところがない．<br>　病理医はもちろん，骨関節の診断や病態に関心のある医療者に広く勧めたい一冊である．<br><br>（「病理と臨床」2025年2月号（43巻2号）掲載）</section></article>
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