食道癌の初期浸潤像とは

Histopathological Definition of Early Invasion of Esophageal Cancer

要旨　食道癌の初期浸潤については明確な定義がない．初期浸潤像は上皮内癌からどのように浸潤し，病変がどのように発育していくのかを知る手がかりになる．また，癌の組織診断基準を確立するうえで重要な所見である．しかし，その病理学的判定方法は病理医間で一致をみていない．食道を専門とする病理医の間では，上皮内癌をより厳密に定義するようになりつつある．日本食道学会病理組織検討委員会では，粘膜固有層に進展する癌上皮は連続性を有していてもpT1a-LPM癌と判定する案が検討されている．その定義はpT1a-LPM癌の病理診断にみられる問題点を解決するものである．まだまだ解決すべき点が多々あるが，臨床医とともによりよい診断基準の確立を目指していきたい．

　There is no clear definition about the early invasion of esophageal cancer, but early invasion reveals the initial developmental process of esophageal cancer. It also establishes the histopathological criteria of early cancer which general pathologists earnestly desire. However, pathologists disagree in their judgment of what constitutes early invasion. The pathological diagnosis of papillary downward growth of cancerous epithelium and cancer micronest differs from pathologist to pathologist.

　Recently the histopathological definition of carcinoma in situ is closely scrutinized by specialized pathologists. If papillary downward growth of cancerous epithelium is found in the lesion, it's depth is diagnosed as pT1a-LPM not pT1a-EP. That definition resolves the problem of diagnostic difference of pT1a-LPM among pathologist. But there are many problems that should be settled histopathologically. And it is necessary to decide histopathological diagnostic criteria in their relationship with endoscopic diagnosis.