食道粘膜の異型性病変と内視鏡所見

Endoscopic Findings of Dysplastic Epithelium of the Esophagus

要旨　食道異型性病変の鑑別をルゴール散布所見を中心に検討した．ルゴール非染部をgrade Ⅲ～Ⅴの3段階に分類し検討を試みると，grade Ⅲは良性病変，grade Ⅳは食道dysplasia，grade Ⅴは扁平上皮癌というように，ある程度組織型の推察ができた．このルゴールによる染色程度の差は非染となる部分のグリコーゲン量を反映している．また，病理学的にdysplasiaと判定された病変の生物学的特徴を細胞核DNA量により検討した．DNAヒストグラムパターンは，異型度が増すにつれてaneuploidyの出現頻度が増加した．核DNA量および分散幅においては，dysplasiaは正常上皮と扁平上皮癌の中間のDNA量を有し，異型度が増すにつれてそれらの増加が認められた．今後経過観察されるdysplasiaの予後を推定する手段として核DNA量測定法の活用が望まれる．

　We studied on classification of the esophageal dysplastic epithelium by lugol method of endoscopy. We divided the lugol-unstained lesions into three grades (grade Ⅲ-Ⅴ)．Grade Ⅲ lesions seemed to correspond to benign lesions and grade Ⅳ lesions dysplastic epithelial lesions. Most of the squamous carcinoma were found in grade Ⅴ lesions. The degree of lugolunstainedness of the esophageal epithelium corresponded to the glycogen contents in the epithelium. We also studied on the DNA contents of lugol-unstained lesions using a fluorescent microscope. As to the analysis of histogram of DNA pattern, the incidence of aneuploidy pattern increased in proportion to the degree of dysplasia. As to the DNA value and the range of it, those of dysplasia are between those of normal epithelium and squamous cell carcinoma, and they also increased with the degree of dysplasia. In the near future, it is expected that the analysis of esophageal dysplasia leads us to estimate its prognosis.