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A Study on the Growth and Development of Squamous Cell Carcinoma of the Esophagus─from Minute Cancer into Mucosal Cancer Kumiko Momma 1 , Junko Fujiwara 1 , Tsuyoshi Katoh 2 , Tairo Ryotokuji 2 , Akinori Miura 2 , Yousuke Izumi 2 , Maiko Kimura 3 , Yuka Kowazaki 3 , Tsunekazu Hishima 4 , Misao Yoshida 5 1Department of Endoscopy, Tokyo Metoropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 2Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 3Department of Gastroenterology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 4Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo 5Foundation for Detection of Early Gastric Carcinoma, Tokyo Keyword: 早期食道癌 , 食道表在癌 , NBI観察 , 内視鏡治療 , 発育進展 pp.1393-1409
Published Date 2012/8/25
DOI https://doi.org/10.11477/mf.1403113575
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 We reviewed results of endoscopic follow up studies on 265patients who underwent endoscopic resection of superficial esophageal cancer from April 2007 to March 2012 and underwent repeated endoscopy after treatment. Thirty three cases developed metachronous esophageal cancer that had been treated by ESD(endoscopic submucosal dissection technique)after endoscopic follow up studies, and finally resected by ESD. Pathological studies had been carried out on the resected specimens. Final pathological diagnoses were squamous cell carcinoma of the esophagus(intraepithelial cancer : T1a-EP 20, cancer with invasion into the lamina propria mucosae : T1a-LPM 7, invasion reachin to the muscularis mucosae : T1a-MM 3 and invasion into the middle third the submucosa : SM2 3). Clinical and pathological results were studied to find macroscopic and histological characteristics of initial cancer lesion of the esophagus, and macroscopic changes in development. NBI(Narrow band imaging)observation and white light observation were employed for screening endoscopies.

 〔Results〕In 23patients, metachronous cancers had been detected as minute cancer lesions less than 5mm in size. Endoscopic findings of them were type 0-IIa 1, 0-IIb 8 and 0-IIc 14. A small and type 0-IIb lesion has been believed as the initial lesion of the squamous cell carcinoma of the esophagus. The size of the initial lesion probably be very small considering the facts that endoscopic findings of the detected minute cancer lesions less than 5mm already included type 0-IIc(61%), 0-IIa(4%)and type 0-IIb(35%). Sizes of the cancer lesions started to increase one or two years after detection, and it took from two to three years to double. Depth of invasion remained within the mucosa while the size of the lesion was less than 10mm. Cancer lesions probably remain within the mucosa more than three years. Endoscopic findings changed in 7cases from type 0-IIb lesion changed into type 0-IIc EP(3cases), type 0-IIc into type 0-I+IIc MM(1), 0-IIb into 0-IIc SM2(2), and0-IIc LPM into 0-IIc SM2(1). Those facts strongly suggested that a squamous cell cancer of the esophagus starts as a small type 0-IIb lesion and it grow and frequently change into type 0-IIc EP, followed by invasion into the lamina propria mucosae(LPM)and finally into the submucosa(SM). Some endoscopic findings strongly suggested very rapid growth of cancer lesions : 1)a mucosal cancer with complicated shape such as branched border or multiple cancers scattered widely, 2)type 0-IIc lesion with partial and white coatings and 3)endoscopic findings suggesting sub epithelial or sub mucosal infiltration. They frequently invade into the submucosa in short time and treatment should be decided and carried out promptly.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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