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Stomach and Intestine(Tokyo) Volume 22, Issue 12 （December 1987）

胃と腸 22巻12号（1987年12月発行）

Japanese English

研究

現行の早期食道癌定義上の問題点―食道表在癌といわゆる早期胃癌およびpm胃癌との病理組織学的比較検討 A Definition of “Early Esophageal Cancer”: Histopathological Comparative Study with So-called “Early Gastric Cancer” 五関謹秀 ^1,3 , 小池盛雄 ² , 滝澤登一郎 ² , 丸山道生 ^1,2 , 吉田操 ¹ , 粟根康行 ¹ , 岩塚迪雄 ¹ Narihide Goseki ^1,3 , Morio Koike ² , Toichiro Takizawa ² , Michio Maruyama ^1,2 , Misao Yoshida ¹ ¹東京都立駒込病院外科 ²東京都立駒込病院病理科 ³東京医科歯科大学医学部第1外科 ¹Department of Surgery, Tokyo Metropolitan Komagome Hospital ²Department of Pathology, Tokyo Metropolitan Komagome Hospital ³Currently The First Department of Surgery, School of Medicine, Tokyo Medical and Dental University pp.1429-1436

発行日 1987年12月25日 Published Date 1987/12/25

DOI https://doi.org/10.11477/mf.1403112878

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要旨　癌の進展様式は癌細胞自体の性格のみならず，発生した場の組織構築によっても著しい差を生ずる．食道壁は胃壁とは異なり，粘膜固有層内でも脈管が発達している．そこで早期食道癌の定義を検討する目的で，食道表在癌21病巣，早期胃癌448例，pm胃癌109例を対象とし詳細な病理組織学的検索を行った．〔成績〕n（＋），ly（＋），v（＋），の頻度をみると，特に食道sm癌では各々30.8％，84.6％，84.6％で，胃pm癌の38.5％，91.7％，70.6％に近い値を示し，他方，食道ep癌，mm癌は，胃m癌，sm癌での頻度に近似していた．〔結果〕食道壁と胃壁の構造の差から，早期胃癌の深達度をsmまでと定義するならば，食道ではmmまでを早期食道癌として扱うべきことが示唆された．

　The biological behavior of the carcinomas, especially the differences in their ways of spreading, depends not only upon the character of the carcinoma itself, but also on the histological difference of the region where it develops. The esophageal wall is different from that of the stomach in that it has a well developed lymphatic and vascular system in the mucosal layer. We made a detailed histological examination of 21 cases of superficial esophageal carcinoma, 448 cases of early gastric carcinoma with 109 cases of gastric carcinoma which had infiltrated the proper muscle layer, in an attempt to redefine early esophageal carcinoma.

　When we examined the incidence of lymph node metastasis (n(+)), lymphatic and vascular permeation by carcinoma (ly(+) and v(+)), we found the occurrence of esophageal sm carcinoma in which infiltration is limited to the submucosa (30.8%, 84.6%, and 84.6%, respectively) was remarkably similar to the incidence of gastric carcinoma which had infiltrated as far as the proper muscle layer (38.5%, 91.7% and 70.6%, respectively).

　On the other hand, the incidence of esophageal ep carcinoma (in which the carcinoma is limited to the squamous epithelium) and esophageal mm carcinoma (in which carcinomatous invasion is limited to the mucosa) is similar to the incidence of gastric m carcinoma (in which infiltration is limited to the mucosa) and gastric sm carcinoma (in which infiltration is limited to the submucosa).

　Conclusion: There is a difference in the sensitivity to cancer in the esophageal wall and the gastric wall structures. Hence, since gastric m and sm carcinomas are defined as “early” gastric cancer, esophageal ep and mm carcinomas should be regarded or defined as “early” esophageal cancer.