Barrett食道癌のX線診断

Radiological Diagnosis of Barrett's Esophageal Cancer

要旨　Barrett食道癌と診断され，切除し病理学的検討がなされた18例20病変の検討では，m癌は3病変，sm癌は9病変で，この12病変の内訳は0-I型4病変，0-IIa型3病変，0-IIc型2病変，0-Ipl＋IIc型1病変で，残り2病変は潰瘍型を示し，全体として隆起型を示す腫瘍が多い傾向にあった．一方，陥凹を有する表在型を呈した腫瘍の中には，mp癌の2病変が含まれていた．腫瘍の組織型は，20病変の中で高分化腺癌12病変，中分化腺癌7病変，乳頭腺癌1病変であった．またBarrett上皮の長さと腫瘍の位置に関しては，一定の傾向はみられなかった．X線検査においては，Barrett上皮は二重造影像により網目状，あるいは顆粒状粘膜として描出され，通常の造影剤の嚥下による撮影にて腫瘍の表面の性状も詳細に描出することができた．さらに本症では造影剤を胃から食道へ逆流させて撮影する方法も有効で，特に隆起性病変の輪郭ならびに表面の性状を明瞭に示すことができた．

　Histological and radiological features of 20 lesions of Barrett's esophageal cancer in 18 cases were examined. These cancers had been removed surgically and pathologicaly confirmed. There were 3 lesions of m carcinoma (stage T1a) and 9 lesions of sm carcinoma (stage T1b) and of these 12 lesions, 4 lesions were macroscopically classified as type 0-I, 3 lesions as type 0-IIa, 2 lesion as type 0-IIc, 1 lesion as type 0-Ipl＋IIc, and the residual 2 lesions had the appearance of ulcerative type. On the other hand, 2 lesions of mp carcinoma were classified as belonging to the superficial type of esophageal cancer. 20 tumors were histopathologically classified into 12 lesions of well differentiated adenocarcinoma, 7 lesions of moderately differentiated adenocarcinoma, and 1 lesion of a papillary carcinoma. No relationship was found in our series between the overall length of Barrett's epithelium and tumor location.

　By radiological examination, Barrett's epithelium was shown by double contrast imaging, to have a reticular or granular pattern and the tumor surface was able to be visualized in detail by having the patient swallow a contrast agent. Furthermore, another approach, which is the technique of manipulating contrast agent backward to the esophagus from the stomach, contributes to visualization of the contour and surface of the tumor, especially in cases of elevated type lesions.

　1) Department of Radiology, Tokai University School of Medicine, Isehara, Japan

　2) Department of Surgery, Tokai University School of Medicine, Isehara, Japan

　3) Department of Diagnostic Pathology, Tokai University School of Medicine, Isehara, Japan