食道m3・sm1癌の臨床病理

The Permeation of Vessels and Lymph Node Metastasis, the High-grade Cytological Atypia of Carcinoma Cells and Sprouting in Superficial Esophageal Carcinoma

要旨　食道表在癌（m2～sm2癌）手術症例36例を対象に，臨床病型，最深部位，細胞異型度，癌胞巣の簇出，脈管侵襲（pv），リンパ節転移（LN）について検討した．深達度に応じてpv（＋）率およびLN（＋）率の有意な上昇を認め，LN（＋）と細胞異型度，pv（＋），簇出との間に有意な相関が認められた．EMRの適応となりうるLN（－）症例は，内視鏡的に目立った隆起や陥凹がなく，組織学的にpv（＋）を認めず，低異型癌で簇出のない症例であった．逆に，高度異型癌かつ簇出陽性という所見は，LN（＋）に対する感度が100％で特異度は76.7％であり，EMR症例の追加治療の判断基準として有用であった．

　Seventeen mucosal carcinoma and nineteen submucosal carcinoma of the esophagus were examined histopathologically, to evaluate the incidence of the permeation of vessels and lymph node metastasis according to the degree of invasion. Mucosal carcinomas were divided into three groups according to the degree of invasion (m2: 8 cases, m3: 9 cases). Submucosal carcinomas were divided into three groups according to the degree of submucosal invasion (sm1: 6 cases, sm2: 13 cases). Mucosal carcinoma did not show lymph node metastasis, but two of the mucosal carcinomas (m2: 1 case and m3: 1 case) revealed the permeation of vessels. Six submucosal carcinomas showed lymph node metastasis (sm1: 1 case, sm2: 5 cases). Carcinomas with deeper invasion had a statistically higher incidence of permeation of vessels (p＜0.02), and a higher incidence of sprouting (p＜0.005). Moreover, the incidence of sprouting was significantly correlated to the incidence of permeation of vessels (p＜0.02), the incidence of high-grade cytological atypia of carcinoma cells (p＜0.05) and the incidence of lymph node metastasis (p＜0.005). When the superficial esophageal carcinoma showed both high-grade cytological atypia of carcinoma cells and sprouting, the likelihood of lymph node metastasis was 100％ (6/6) and the specificity was 76.7％ (23/30).

　In conclusion, esophagectomy with lymphadectomy or radiotherapy might be a suitable treatment for superficial esophageal carcinomas with high-grade cytological atypia of carcinoma cells and sprouting.