食道疾患における病理診断の最前線

Recent Advances in the Pathological Diagnosis of Esophageal Diseases：A Practical and Integrative Approach

要旨●食道疾患の診断において病理学的評価は治療方針決定に直結する重要な基盤である．近年の内視鏡技術の進歩により小病変の検出が可能となり，病理診断の精度と再現性の向上が求められている．一方，食道粘膜は炎症や再生に伴う形態変化を呈しやすく，腫瘍と非腫瘍の組織学的鑑別には困難を伴うことがある．これらの克服には，組織構築，細胞異型，背景所見，臨床情報の統合的評価に基づく診断アプローチが重要である．また，免疫組織化学染色の適切な運用による診断精度と再現性の向上が期待される．

　Pathological evaluation is an important component of diagnosing esophageal diseases and has a direct impact on clinical decision-making. Recent advances in endoscopic technology have enabled the detection of increasingly smaller lesions, emphasizing the need for greater accuracy and reproducibility in pathological diagnosis. However, the esophageal mucosa is prone to morphological changes associated with inflammation and regeneration, which may complicate the distinction between neoplastic and non-neoplastic lesions. An accurate diagnosis necessitates an integrated evaluation of tissue architecture, cytological atypia, background histological findings, and relevant clinical data. Furthermore, appropriate application of immunohistochemistry can enhance diagnostic accuracy and reproducibility.