Superficial Esophageal Cancer with Appearance of Submucosal Tumor ― Clinical and Endoscopic Characteristics Kumiko Momma 1 , Misao Yoshida 2 , Yoshiya Yamada 3 1Department of Endoscopy, Tokyo Metropolitan Komagome General Hospital 2Department of Surgery, Tokyo Metropolitan Bokutoh Hospital 3Department of Gastroenterology, Tokyo Metropolitan Komagome General Hospital Keyword: 粘膜下腫瘍様食道表在癌 , 小細胞型未分化癌 , 類基底細胞癌 , 腺様囊胞癌 , 腺扁平上皮癌 pp.1505-1518
Published Date 2003/10/25
DOI https://doi.org/10.11477/mf.1403100739
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 Some superficial esophageal cancers are observed as protruding lesions, covered by esophageal mucosa and look like submucosal tumors. The tumor tissue occupies the subepithelial layer and cancer invasion frequently reaches is still the submucosa. Their early detection and differential diagnosis are difficult. Many pathological studies concerning them have revealed that particular histological types are frequently noted among them. These types are lesions such as undifferentiated carcinoma, basaloid squamous carcinoma, adenoid cystic carcinoma, adeno-squamous carcinoma, mucoepidermoid carcinoma and poorly differentiated squamous cell carcinoma. Compared with squamous cell carcinoma of the esophagus, they have malignant clinical features such as frequent lymph node metastasis and distant organ metastasis. Differential diagnosis on these cancers is essential for selection of treatment. Conventional endoscopy should be carried out observing the shape of the tumor(its height, margin, irregularities of the surface)and concomitant mucosal cancer. Protruding lesions with a wide base (type 0-Ipl)are highly likely to be undifferentiated carcinomas on adenoid cystic carcinomas. Basaloid carcinomas are identified as protruding tumors with ill-defined borders or sometimes with narrow bases(polypoid type : type 0-Ip). Protruding lesions with nodular and irregular shapes are suggestive of adenoid cystic carcinomas. These features are less prominent among undifferentiated carcinomas and basaloid carcinomas. Basaloid carcinomas frequently accompany mucosal cancers (squamous cell carcinoma)on the top of the protruded lesion. Slightly depressed types (type 0-IIc)are more common among adeno-squamous carcinomas. In order to get tumor tissues from under the esophageal mucosa, bite biopsy should be repeated at the same site of the tumor. Sometimes aspiration cytology by fine needle puncture is useful for differential diagnosis.

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