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要旨●食道の上皮下腫瘍もしくは上皮下腫瘍様病変〔まとめて上皮下発育を来す病変(癌腫も含む)を本稿では上皮下病変(subepithelial lesion ; SEL)として扱う〕の通常内視鏡診断には,病変の形態,硬さ,色調,被覆上皮の性状(上皮性変化の有無や程度)を観察することが重要である.おのおののSELの由来となる細胞が上皮下で腫瘍性増殖あるいは反応性増殖を来すことでSELを形成する.腫瘤の主座は,その腫瘤の由来となる組織が存在する部位に相当する場合が多い.また,腫瘤の発育様式や性質を把握することで上記の特徴(形態,硬さ,色調)を推測することが可能である.これに腫瘤がもつ上皮との親和性を考慮し,上皮性の変化の有無や程度といった被覆上皮の性状を判断し,内視鏡的診断を行う.本稿では「臨床・病理 食道癌取扱い規約 第12版」に記されている腫瘍および腫瘍様病変のうち上皮下発育を呈するSELを中心に解説を行った.
The routine endoscopic diagnosis of a subepithelial tumors or subepithelial tumor-like lesions, which are subepithelial growths, including carcinomas, referred to as SEL(subepithelial lesions), must also be examined for lesion morphology, consistency, color tone, and properties of the coated epithelium(status and extent of epithelial changes). The cells derived from SEL undergo subepithelial neoplastic or reactive proliferation. The primary site of a mass is often located near its site of origin in the tissue. It is also possible to infer the above characteristics(morphology, hardness, and color tone)by understanding the developmental pattern and nature of the mass. Considering the affinity the mass has for the epithelium, the nature of the coated epithelium, such as the status and extent of epithelial changes, is examined to make an endoscopic diagnosis. This study focuses on SEL with subepithelial growth among tumors and tumor-like lesions described in the regulations for handling clinical and pathological esophageal cancers(12th edition).
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