New Definition and Macroscopic Characteristics of Early Carcinoma of the Esophagus Hidenobu Watanabe 1 1The First Department of Pathology, Niigata University School of Medicine Keyword: 早期食道癌 , 定義と肉眼診断 , 食道粘膜内癌 , 脈管侵襲とリンパ節転移 pp.1075-1086
Published Date 1990/9/25
DOI https://doi.org/10.11477/mf.1403111407
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 In Japan, early carcinoma of the esophagus is defined as carcinoma invading down to the submucosa without lymph nodal metastasis, and superficial carcinoma as that limited to the mucosa or submucosa regardless of nodal metastasis. Such usage is complicated and inconvenient.

 We reevaluated the present definition and tried to make a new definition of esohageal early carcinoma and find out its macroscopic characteristics.

 Our files had 11 ep-carcinoma cases (intraepithelial squamous cell carcinoma), 8 mm-carcinoma cases (scc. invading the lamina propria mucosae or muscularis mucosae), and 37 sm-carcinoma cases (scc. invading the submucosa), which were all examined on resected lymph nodes histologically. To the number of the tumors of these cases were added the tumors of other cases without histological examination of lymph nodes. In total, there were 88 lesions of ep-carcinoma type, 17 mm-carcinoma type, and 48 lesions of sm-carcinoma type.

 Lymph nodal metastasis was negative in all of the ep-carcinoma and mm-carcinoma cases, but positive in 30% of the sm-carcinoma cases. Lymphatic permeation was 0% in all ep-carcinoma lesions, 6% in the mm-carcinoma, and 60% in the sm-carcinoma, while venous permeation was 0%, 6% and 68% respectively in each. It is reported that 5-year-survival rate is 90-100% in epcarcinoma and mm-carcinoma patients, and that recurrence-rate is 0% in ep-, mm-carcinoma and 10% in smcarcinoma.

 Therefore, early carcinoma of the esophagus should be defined as intramucosal carcinoma regardless of lymph nodal metastasis.

 Intramucosal carcinoma was distinguished by swelling of the circular folds, or granular mucosa with a white or yellowish-white or yellowish-brown color in the formalin-fixed material, and it belonged to one of the macroscopic types, i.e., Ⅱa type (1 mm or less in height), Ⅱb type, Ⅱc type (down to 0.5 mm in depression), Ⅱa+Ⅱb type or Ⅱc+Ⅱb type.

 On the other hand, submucosal carcinoma had features of a 5 mm or more mucosal nodule or aggregated nodules with smooth-surface, brown color and often surface-erosions (Ⅰ type, more than 1 mm in height), or a smooth-surfaced, brown, and eroded depression (Ⅱc-type), or still deeper depression (Ⅲ-type).

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