食道胃接合部腺癌のX線診断―存在診断，深達度診断，食道浸潤診断

X-ray Studies of Adenocarcinoma of the Esophagogastric Junction

要旨　1998年8月から2008年7月までに南風病院で外科手術および内視鏡治療が行われた食道胃接合部腺癌107例112病変を対象とした．Barrett腺癌は6病変で，Barrett腺癌を除く106病変中表在癌は72病変，進行癌は34病変で，小彎および後壁を中心とする病変が多かった．表在癌は陥凹主体の病変が多く，ほとんどが分化型癌であった．食道浸潤が72病変中11病変（15.3％）にみられた．M癌の浸潤距離は平均2mm（1～3mm）でSM癌の浸潤距離は平均3.8mm（1～8mm）であった．進行癌では食道浸潤が34病変中22病変（64.7％）にみられ，浸潤距離は平均11.6mm（1～39mm）であった．管腔の狭い食道胃接合部においてX線検査は腫瘍の全体像を客観的に捉えることが可能であった．進行癌はほとんどが2型と3型でありX線検査での存在診断は容易であった．表在癌でも隆起を主体とする病変は境界明瞭な透亮像として存在診断は比較的容易であったが，IIc病変は肉眼所見に乏しい病変が多くみられた．周囲との境界が明瞭であれば粘膜下浸潤が疑われ，陥凹底に隆起を示す透亮像がみられれば粘膜下層深部浸潤の可能性が考えられた．表在癌にはひだ集中所見を伴った病変はなく，ひだ集中像を伴う症例はすべて進行癌であった．SM癌は線状分離像の不整や食道胃接合部より口側の粘膜不整像を読み取ることで食道浸潤の診断は可能であった．進行癌もほとんどの病変で食道胃接合部と食道浸潤による肉眼的境界を同定することにより，食道浸潤範囲の推測が可能であった．SSBEに伴うBarrett腺癌は右壁および後壁に多く，X線検査では半立位仰臥位第二斜位像や腹臥位第一斜位像が存在診断に有用であった．

　One hundred and seven patients〔84 males and 23 females, average age 71（41～93）〕with adenocarcinoma of the gastroesophageal junctions（112 lesions）treated by surgery or endoscopic treatment at Nanpu Hospital from August 1998 to July 2008 were evaluated retrospectively. Six lesions were Barrett's carcinomas. Other lesions were mucosal or submucosal carcinomas（72）and advanced carcinomas（34）. Average tumor sizes were 24.4mm for mucosal or submucosal carcinomas and 64.3mm for advanced carcinomas. The center of the tumor was located in the lesser curvature or posterior wall in 85％of cases. Rates of submucosal invasion by tumor size were 30％ for 10mm or less,28％ for 11 to 20mm,46％ for 21 to 30mm, and 75％ for 31 or more. Macroscopic type of mucosal and submucosal carcinoma was predominantly depressed with most tumors well differentiated carcinomas. 11 of the 72 lesions（15.3％）had esophageal invasion, with average invasion being 2mm（1～3mm）in mucosal and 3.8mm（1～8mm）in submucosal carcinomas. Twenty-two of the 34 advanced carcinomas（64.7％）had esophageal invasion with an average invasion of 11.6mm（1～39mm）. X-ray examination is useful for the getting a whole image of a lesion in the narrow lumen of the eosophago-gastric region ; making detection of advanced carcinomas easy. Mucosal or submucosal carcinomas, if a protruded types, are easy to detect as radiolucent lesions with clear margins. For superficial depressed types, the area of a mucosal carcinoma was not clearly traced. Most submucosal carcinomas were, however, clearly traced on an X-ray examination and radiolucency showing in a depressed area suggested the carcinoma had invaded deeply into the submucosal layer. In mucosal and submucosal carcinomas there were no lesions with convergent folds ; all lesions with convergent folds were advanced carcinomas. Esophageal invasion was able to be diagnosed from the irregularity of the EGJ or lower esophagus in submucosal and advanced carcinomas. Because most Barrett's carcinoma with SSBE are located in the right or posterior wall ; half-standing, prone, right anterior, oblique and half-standing, supine, left anterior, oblique projections are useful in double-contrast studies.