食道表在癌の深達度診断―肉眼病理の立場から

Gross Pathology of Tumor Invasion by Superficial Esophageal Carcinoma

要旨　食道表在癌183例201病変（粘膜内癌159病変，粘膜下層浸潤癌42病変）のホルマリン固定検体を用いて，その肉眼的特徴を検討した．その結果，高い確率で癌が粘膜下層に大量に浸潤していると推定される肉眼所見は，以下の2点に要約された．1つは，“立ち上がりがなだらかなドーム状の隆起"で，組織学的には，大量の癌組織が直上の上皮層を押し上げて隆起を形成したものである．もう1つは，“明瞭なびらん・潰瘍を伴う陥凹"で，組織学的には，大量の癌組織が，粘膜深部や粘膜下層に浸潤することにより，直上の粘膜組織（多くは粘膜内癌巣）が自壊・脱落し，同部に癌性びらん・潰瘍を伴ったと推定されたものである．以上の特徴の指摘とともに肉眼観察による食道表在癌の深達度診断の有用性と陥穽について付言した．

　The aim of this study was to clarify the macroscopic features of superficial esophageal carcinoma. We examined 201 lesions from 183 cases with superficial esophageal carcinoma（intramucosal carcinoma and submucosal invasive carcinoma : 159 and 42 lesions, respectively）.

　The following conclusions were obtained. The macroscopic findings indicating that the tumor had invaded massively into the submucosal layer of the esophagus were“dome-like elevated lesions sloping up gently"and“depressed lesions with distinct ulceration at their surface". Histologically, the former consisted of surged up squamous epithelial layer caused by the carcinoma invading the subepithelial tissue, the latter were formed by the carcinoma with massive submucosal invasion.

　We pointed out the above-mentioned macroscopic features and commented on the benefit and pitfalls in the diagnosis of depth of tumor invasion.