Barrett食道の病理組織学的検討―特にspecialized columnar epitheliumについて

A Histopathological Study of Barrett's Esophagus with Special Reference to the Specialized Columnar Epithelium

要旨　Barrett食道の円柱上皮(Barrett上皮)の特徴を文献的に考察すると共に，自験例におけるBarrett上皮の病理組織像を提示した．またBarrett上皮の特徴と考えられているspecialized columnar epithelium(SCE)を，胃の腸上皮化生と比較検討した．その結果SCEは形態像，粘液の性状，また免疫組織学的検索などからも，胃の腸上皮化生と酷似していた．Barrett食道に出現するSCEは，胃や腸の正常上皮には見られないという点で，特殊な上皮と考えられているが，SCEは本質的には腸上皮化生と同じであり，腸上皮化生粘膜は胃ではごく普通に見出されるもので，決して特殊な上皮ではない．それゆえにBarrett上皮に混乱や誤解を起こす可能性のあるSCEなる用語を用いないよう強調した．

　Literature review was made on Barrett's esophagus, in particular, on morphological characteristics of the columnar epithelium (Barrett's epithelium). Histopathological findings in two cases we experienced were presented as well. We compared the specialized columnar epithelium (SCE) of Barrett's esophagus, which have been thought to be pathognomonic for this disease, with the epithelium of gastric intestinal metaplasia. Morphological study as well as mucin histochemistry and immunohistochemistry indicated that SCE had similar characteristics to the epithelium of gastric intestinal metaplasia.

　The SCE of Barrett's esophagus has been considered morphologically distinctive from the normal lining epithelium of the gastrointestinal tract. According to our studies, however, SCE is not distinguished from the epithelium of gastric intestinal metaplasia, which is commonly seen but not considered as specialized epithelium.

　We stress here that one should not use the term "specialized columnar epithelium", because it is not specialized and it may provoke misunderstanding and confusion in the study of pathogenesis of Barrett's esophagus.