Barrett上皮の病理学的特徴

Histopathology of Barrett's Epithelium

要旨　食道胃接合部の組織学的所見をBarrett食道・食道癌・胃噴門癌の間で比較し，Barrett上皮にどのような特徴があるかを述べた．Barrett食道の噴門腺粘膜では，腸上皮化生が他の2疾患に比べて少ないにもかかわらず，なぜ腸上皮化生が好発するのか，更にBarrett上皮にみられる腸上皮化生の新しい分類法とその意義，食道噴門腺粘膜からの腸上皮化生の発生・進展についても考察を加えた．

　We studied features of Barrett's non-neoplastic epithelium found in Barrett's adenocarcinomas in comparison with gastric and esophageal cardiac mucosa of squamous cell carcinomas of the lower esophagus and cardiac carcinomas of the stomach.

　Both of the gastric and esophageal cardiac mucosa was present in three conditions. The total length of both mucosa was similar among three conditions (arange : 5.0 ～ 13.0 mm). Esophageal squamous cell carcinoma and gastric cardiac showed a high incidence of intestinal metaplasia, each 4/8 and 4/6, respectively, but Barrett's esophagus a low (1/9, a mild grade). The metaplasia in non-Barrett's cases first developed in gastric cardiac mucosa and extended to distal part of the esophageal cardiac. Barrett's esophagus showed an extensive metaplasia from distal part of the esophageal cardiac mucosa, though the cardiac mucosa did not have intestinal metaplasia. We discussed on why intestinal metaplasia is so severe in Barrett's esophagus, and on the developing point and extension of intestinal metaplasia in Barrett's esophagus, and last presented a new classification of intestinal metaplasia occurring in Barrett's epithelium.