悪性度の高い食道表在癌―臨床病理学的特徴

Aggressive Superficial Esophageal Carcinoma: Its Clinicopathological Characteristics

要旨　食道表在癌（扁平上皮癌）の高悪性度に関連する組織学的因子を評価した．壁深達度T1a-MMが11例とSMが53例，計64症例の外科切除材料を対象とし，組織学的因子とリンパ節転移との関連およびリンパ節転移個数や病期（TNM分類）との関連を検討した．壁深達度T1a-MMよりSMのほうがリンパ節転移の頻度は高かったが，浸潤度（距離）はリンパ節転移の危険性評価には有用ではなかった．検討した組織学的因子のうち，胞巣分化（－），不整胞巣（＋），簇出（＋），ly（＋）の4因子がリンパ節転移の危険因子として抽出された．そして，リンパ節転移個数の多いものではこれら4因子の出現数が多くなるほど，リンパ節転移率やより進行した病期のものが多くなり，悪性度評価にこれらの4因子が有用であることが示唆された．

　We evaluated the histological factors associated with aggressiveness of superficial esophageal carcinoma（squamous cell carcinoma）. Sixty-four surgically resected cases（depth T1a-MM : 11 cases, SM 53 cases）were objects for this study. The correlation between histological factors and number of metastasized lymph nodes or TNM stage was investigated. The frequency of lymph node metastasis was higher in cases of depth SM than those of depth T1a-MM, however, distance of invasive depth was not useful for risk assessment of lymph node metastasis. Among the histological factors, 4 factors（dedifferentiation, lymphatic permeation, budding, and irregular nests）were extracted as risk factors for lymph node metastasis. The larger the total number of presence of the risk factors was, the more TNM stage advanced and the higher incidence lymph node metastasis were seen. It is suggested that these four risk factors are useful for evaluation of tumor aggressiveness.