Japanese

Endoscopic Diagnosis of Meso and Hypo-pharyngeal Carcinoma in Early Stage Kumiko Momma 1 , Junko Fujiwara 1 , Tsuyoshi Kato 2 , Tairo Ryotokuji 2 , Akinori Miura 2 , Yousuke Izumi 2 , Hiroki Sato 1 , Hideto Egashira 3 , Naoto Egawa 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 Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Internal Medicine, 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: 中・下咽頭表在癌 , 内視鏡診断 , 通常観察 , NBI観察 , 微小癌 pp.203-216
Published Date 2010/2/25
DOI https://doi.org/10.11477/mf.1403101851
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 Recent development of upper GI endoscopy allowed us to find pharyngeal cancer in early stage. Studies on clinico-pathological characteristics of them probably promote endoscopic early detection of pharyngeal cancer.

 In order to know endoscopic and pathological characteristics of pharyngeal cancer in early stage, patients with superficial pharyngeal cancer treated by EMR(endoscopic mucosal resection)were studied.

 63 patients with 84 superficial cancer lesions in the pharynx were studied. All of them underwent Upper GI endoscopy and superficial cancer lesions were detected and treated by EMR. All of them were male and 68 year-old in average. Malignant lesions in other organ than pharynx were frequently 98.4%(esophagus 93.6%, head and neck 3% and stomach 1.6%). All pharyngeal lesions were detected by UGI endoscopy(by white light observation 76%, by NBI(narrow band imaging)16% and by iodine staining 8%). Type IIb cancer(flat lesion)occupied 86% of all lesions identified only by iodine staining while conventional white light or NBI observation failed. Macroscopic characteristics of superficial pharyngeal cancers were as follows. (1) multiple cancers were frequent(39% : synchronous 24% and metachronous 14%). (2) Hypopharyngeal cancers were most frequent(82%)while mesopharyngeal cancers in 18% of all cases. (3) Elevated type occupied 54% of all cases(0-I 6%, 0-IIa 43%, 0-IIa+IIc 5%), while flat type(type 0-IIb)31% and slightly depressed type(type 0-IIc)13%. (4) Pathological studies on resected specimens revealed that the depth of cancer invasion was confined to the epithelium in 81% of all lesions and reaching to the subepithelial layer 19% including 3 cases(19% : 2 cases with type 0-I lesions that had wide subepithelial invasion and 1 type 2 lesion)with micro-vascular permeation suggesting probability of metastasis.

 Considering those facts, cancer invasion probably be confined to the epithelium when cancer lesions showed flat type(type 0-IIb), slightly elevated type(type 0-IIa)with smooth surface and slightly depressed type(type 0-IIc)without slight elevation close to the cancer lesion. On the other hand, subepithelial invasion should be suspected when a type 0-I lesion was tall and had wide base, a type 0-IIc lesion had irregular surface or slight elevation close to the depression, and combined type such as type 0-IIa+IIc.


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