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Stomach and Intestine(Tokyo) Volume 47, Issue 9 （August 2012）

胃と腸 47巻9号（2012年8月発行）

Japanese English

今月の主題食道癌の発育進展─初期浸潤の病態と診断

主題

肉眼形態と血管形態からみた発育進展―主に0-IIcに関する発育進展 Transformation of Microvascular Pattern and That of Macroscopic Type in Early Stage of Esophageal Squamous Cell Carcinoma 平澤大 ¹ , 藤田直孝 ¹ , 前田有紀 ¹ , 尾花貴志 ¹ , 菅原俊樹 ¹ , 大平哲也 ¹ , 原田喜博 ¹ , 小池良樹 ¹ , 鈴木憲次郎 ¹ , 山形拓 ¹ , 日下順 ¹ , 田中恵 ¹ , 野田裕 ¹ Dai Hirasawa ¹ , Naotaka Fujita ¹ , Yuki Maeda ¹ , Takashi Obana ¹ , Toshiki Sugawara ¹ , Tetsuya Ohira ¹ , Yoshihiro Harada ¹ , Yoshiki Koike ¹ , Kenjiro Suzuki ¹ , Taku Yamagata ¹ , Jun Kusaka ¹ , Megumi Tanaka ¹ , Yutaka Noda ¹ ¹仙台市医療センター仙台オープン病院消化器内科 ¹Department of Gastroenterology, Sendai City Medical Center, Sendai Open Hospital, Sendai, Japan キーワード：拡大内視鏡 , NBI , 食道表在癌 , 食道学会拡大内視鏡分類 , avascular area Keyword: 拡大内視鏡 , NBI , 食道表在癌 , 食道学会拡大内視鏡分類 , avascular area pp.1383-1392

発行日 2012年8月25日 Published Date 2012/8/25

DOI https://doi.org/10.11477/mf.1403113574

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要旨　食道表在扁平上皮癌の初期浸潤例にみられる肉眼形態や血管形態の変化を検討することを目的とした．当科でESDを行った表面型の食道表在扁平上皮癌78病変を対象とし，腫瘍径，肉眼形態，組織学的深達度，血管形態に関してretrospectiveに検討を行った．血管形態に関しては食道学会分類（案）をもとに分類を行った．0-IIa型と0-IIb型は腫瘍径が小さい傾向で，深達度はT1a-EPの占める頻度が高く，血管形態はほとんどがType B1であった．一方，0-IIc型は腫瘍径が大きく，T1a-LPM以深の病変が多かった．以上から，0-IIa型と0-IIb型は0-IIc型と比較して浸潤傾向が少ない，もしくは0-IIc型の先行病変だと考えた．0-IIc型は深達度がT1a-EP～T1b-SM2まで存在し，血管形態も多彩であったが，癌が浸潤するに従い（1）Type B1＋AVA none→（2）Type B1＋AVA-small→（3）Type B2＋AVA-small→（4）Type B2＋AVA-none→（5）Type B3となる傾向を認めた．（1）はEPかLPM，（2）（3）はLPM，（4）で半数強がMM，（5）でSM浸潤が多くみられた．

　The aims of this study were to assess the transformation of the morphologic patterns of microvessels and of macroscopic type in the early phase of esophageal SCC（squamous cell carcinoma）. Seventy-eight lesions of superficial esophageal SCC which were resected by ESD（endoscopic submucosal dissection）in our department were enrolled in this study. Tumor size, macroscopic type, invasion depth and microvascular pattern were evaluated. Morphologic patterns of microvessels were classified according to the draft classification of the Japan Esophageal Society.

　Type 0-IIa and type 0-IIb lesions in their macroscopic type tended to be small, and their invasion depth was more likely to be EP. According to the draft classification of the Japan Esophageal Society, morphologic patterns of microvessels of type 0-IIa and type 0-IIb lesions are more likely to be Type B1. On the other hand, the size of type 0-IIc lesions tended to be large, and their invasion depth was more likely to be T1a-LPM or deeper. These findings indicate that type 0-IIc lesions may be more able to invade deeper than type 0-IIa and 0-IIb lesions. Also, type 0-IIa and type 0-IIb lesions might precede type 0-IIc lesions.

　The invasion depth of type 0-IIc lesions varied from T1a-EP to T1b-SM2. Morphologic patterns of microvessels of type 0-IIc lesions also varied. Invasion depth of carcinoma tended to increase in relation to the morphologic patterns of microvessels as follows :（1）Type B1＋AVA-non→（2）Type B1＋AVA-small→（3）Type B2＋AVA-small→（4）Type B2＋AVA-non→（5）Type B3.

　Invasion depth of（1）lesions was T1a-EP or LPM, and that of（2）lesions and（3）lesions was T1a-LPM. More than half of the（4）lesions had invaded the T1a-MM, and a large number of（5）lesions invaded the SM.