Japanese

Endoscopic Estimation of Depth of Invasion in Cases with Small and Minute Squamous Cell Carcinoma of the Esophagus Kumiko Momma 1 , Junko Fujiwara 1 , Hideto Egashira 2 , Naoto Egawa 2 , Tairo Ryotokuji 3 , Akinori Miura 3 , Tsuyoshi Kato 3 , Yousuke Izumi 3 , Yoko Tateishi 4 , Tetsuo Nemoto 4 , Misao Yoshida 5 1Department of Endoscopy, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Internal Medicine, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 食道微小癌 , 食道小癌 , 深達度診断 , 内視鏡治療 pp.1697-1712
Published Date 2009/10/25
DOI https://doi.org/10.11477/mf.1403101778
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 In order to find clinical and pathological features of small squamous cell carcinomas of the esophagus,88 cases with 93 small cancer lesions were analyzed in this study. They occupied 18.2% of 417 cases with superficial and squamous cell carcinoma of the esophagus that underwent endoscopic resection from January 2005 to June 2009.

 Results:(1)54 cases(13% of all cases)had 56 small cancer lesions less than 10mm in size and 34 cases(8%)had 37 minute cancer lesion less than 5mm.(2)In cases with minute cancers(37), 4 lesions(11%)could be classified into type 0-IIa, 13 lesions(35%)type 0-IIb, 19 lesions(51%)type 0-IIc and 1 lesion(3%)type 0-I. Type 0-IIb and type 0-IIc lesions occupied 86% of all minute squamous cell carcinoma lesions. Pathological studies on resected specimens revealed that 35 lesions(95% of all minute cancer lesions)remained in the epithelium(EP), one lesion(2.5%)infiltrated into the lamina propria mucosae(LPM)and also another one lesion(2.5%)reached to the muscularis mucosae(MM). One minute LPM cancer was a type 0-IIc lesion and another MM lesion was type 0-I.(3)In cases with small cancers(56), 3 lesions(5% of all lesions)were type 0-IIa, 14(25%)0-IIb, 38 lesions(68%)type 0-IIc and one(2%)type 0-I. Type 0-IIb and 0-IIc lesions occupied 93% of all minute cancer lesions. Fourty one lesions(73% of all small cancer lesions)were EP cancers, 3 lesions(6%)LPM, 8(14%)MM and 4(7%)invaded moderately into the submucosa(SM2). EP and LPM cancer lesions occupied 80% of all small cancers while residual 20% included lesions with deeper invasion into MM and SM2. All eight lesions with MM invasion were type 0-IIc cancers, three of four SM2 cancers were also type 0-IIc and one lesion was type 0-I lesion. Microvascular permeation was noted in 2 among 8 MM cancers(25%)and 2 among 4 SM2 cancers(50%), suggesting probable lymph node metastasis.(4)EP and LPM cancers occupied 86% of all small and minute cancers and MM and SM 14%. Endoscopic differentiation of type 0-IIc lesions with deeper invasion is most important in endoscopy, for type 0-IIc occupied 85% of all small and minute cancers with MM or SM invasion. Partial and deeper depression, partial and dark reddening, granular irregularities in the depressed area and marginal elevation of type 0-IIc lesions strongly suggested deeper invasion at conventional endoscopy. Abnormalities in IPCL by NBI observation are suggestive of deeper invasion.

 Conclusions:(1)Type 0-IIb and 0-IIc lesions occupied 90%(IIb : 29% and IIc : 61%)of all small and minute cancers. (2)EP and LPM cancers occupied 86% of all small and minute cancers. (3)Differentiation of type 0-IIc cancers with MM and SM invasion is point of endoscopic diagnosis on small and minute squamous cell carcinoma of the esophagus, for type 0-IIc lesions occupied 85% of all MM and SM cancers.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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