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Clinicopathological Features of the Avascular Area Mika Tsunomiya 1 , Miwako Arima 1 , Ayataka Ishikawa 2 , Yu Nishimura 2 1Division of Endoscopy, Saitama Cancer Center, Saitama, Japan 2Division of Pathology, Saitama Cancer Center, Saitama, Japan Keyword: 食道表在癌 , 拡大内視鏡分類 , avascular area , AVA , baran , mesh pp.1384-1392
Published Date 2018/9/25
DOI https://doi.org/10.11477/mf.1403201482
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 The Japan Esophageal Society uses magnifying endoscopic classification to define AVA as a low or no vascularity area surrounded by type B vessels. Any type of AVA(small, medium, or large)surrounded by type B1 vessels is suggestive of T1a-EP or T1a-LPM squamous cell carcinoma. However, in reality, type B1 and B2 vessels surrounding the AVA are often confused. Recognition of the size of the AVA and the AVA itself varies from person to person. This chaos leads to variance in diagnosis of invasion depth. Here, we classified non-loop vessels surrounding the AVA into non B2-AVA and B2-AVA according to the presence of a tetrad of morphological factors of the vessels:dilation, weaving, irregular caliber, and different shape. Non B2-AVAs are subclassified into typical AVAs:small, of a soccer ball appearance ; mesh, wherein there are ring-like vessels around AVAs that accumulate and part of the ring structure is broken ; and baran, wherein baran-like vessels around the AVA wave vertically and fuse on the surface. We subsequently investigated the pathology and studied the clinicopathological features of the classified AVAs. Non B2-AVA is less invasive. Mesh and baran AVAs are thought to be variations of the AVA-small with soccer ball appearance. Conversely, B2-AVAs have invasive characteristics:the subepithelial papillary structure is broken and the caliber and direction of the vessels is irregular. Extracting B2-AVAs and differentiating them from non B2-AVAs is essential for accurately diagnosing the invasion depth of superficial esophageal cancer.


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

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