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要旨●口腔粘膜は角化および非角化重層扁平上皮に覆われ,扁平上皮癌が発生する.発生頻度は舌で最も高く,歯肉,口腔底,頰粘膜,口蓋の順となるが,食道癌との合併頻度が高いのは口腔底・頰粘膜癌である.咽頭は上,中,下咽頭から成り,非角化重層扁平上皮に覆われる.上・中咽頭には扁桃のリンパ装置が存在する.喉頭粘膜は大部分が多列線毛上皮に覆われるが,喉頭蓋の一部と声帯部分は重層扁平上皮が覆う.発生する悪性腫瘍では,いずれの領域も扁平上皮癌が多い.上咽頭にはリンパ球浸潤を伴う鼻咽頭癌が発生し,ほとんどの症例にEBV感染が証明される.中咽頭癌はHPV陽性癌と陰性癌とで予後を含めた性格が異なると考えられ,病理診断の際にはp16免疫組織化学染色を行う.下咽頭の扁平上皮癌は,拡大内視鏡で認識される腫瘍血管パターンを含め,食道と類似した形態を呈する.下咽頭は食道と異なり粘膜筋板が存在しないが,食道では粘膜固有層浸潤(T1a-LPM)と粘膜下層浸潤(T1b-SM)とが同等でないものとしていることを考慮し,下咽頭癌の上皮基底層を越える浸潤の表現として,上皮直下の結合組織を粘膜下層ではなく“上皮下層”と呼ぶ.
The oral mucosa is covered with keratinized and nonkeratinized squamous epithelium, giving rise to squamous cell carcinoma, and its incidence is highest in the tongue, followed by the gingiva, oral floor, buccal mucosa, and the palate. In contrast, the incidence of esophageal cancer is high in the buccal and oral floor mucosae. The pharynx comprises the upper pharynx, middle pharynx, and hypopharynx and is covered with nonkeratinized squamous epithelium. The upper pharynx and middle pharynx consist of the lymphoid apparatus of the tonsils. Most of the laryngeal mucosa is covered with ciliated epithelium, but a part of the epiglottis and vocal folds are covered with squamous epithelium. Squamous cell carcinoma is the most commonly occurring malignant tumor in all the regions. Nasopharyngeal carcinoma develops in the nasopharynx with dense lymphocytic infiltration and is usually accompanied by the Epstein−Barr virus infection. Oropharyngeal cancer has different characteristics, including prognosis, between human papilloma virus-positive and negative cancers, and the requirement of p16 immunostaining for pathological diagnosis. However, the morphologies of squamous cell carcinoma of the hypopharynx and esophagus, including the tumor vascular pattern detected using magnifying endoscopy are similar. Unlike the esophagus, there is no muscularis mucosae in the hypopharynx. Thus, the connective tissue immediately below the epithelium should be termed the “subepithelial layer” instead of the submucosal layer.
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