食道胃接合部腺癌の病理—特に肉眼像からみた深達度診断

Pathological Characteristics of Esophagogastric Junction Cancer：Macroscopic Diagnosis of the Depth of Invasion

要旨●食道胃接合部腺癌（Barrett食道癌および食道胃接合部より2cm以内に腫瘍の中心がある腫瘍）のESD標本および手術標本の肉眼画像を用いて，深達度診断に利用される肉眼所見の精度を検討した．通常胃癌で用いられる粘膜下層浸潤を疑う所見を使用すると，500μmを超える粘膜下層浸潤を診断するのに特異度が高いが感度は低かった．粘膜下層浸潤を示した食道胃接合部癌の特徴は，隆起主体の病変では腫瘍が台状の挙上を示す“立ち上がりが非癌粘膜”を伴うことが多く，病理組織学的には粘膜下層での粘液癌成分や腫瘍の充実性増殖を示すものが多く認められた．陥凹主体の病変では癌巣内潰瘍を伴う症例はまれであることが特徴で，“陥凹辺縁隆起”，“陥凹内結節状隆起”の所見を示す症例が多く認められた．

　We examined the accuracy of macroscopic findings to diagnose the depth of invasion in esophagogastric junction adenocarcinoma using photographs of resected specimens obtained from endoscopic submucosal dissection or surgery. Based on the findings suggesting submucosal invasion in gastric cancer, the specificity of diagnosing submucosal invasion deeper than 500μm was high, but the sensitivity was low. A protruded lesion with a “table-like” appearance is characteristic of esophagogastric junction carcinoma with submucosal invasion. Histologically, lesions showed mucinous carcinoma or solid tumor growth. In addition, the depressed lesions were rarely accompanied by ulcerations. A “recessed marginal ridge” and a “nodular lesion in the depression” were additional findings of esophagogastric junction adenocarcinoma.