食道癌に伴う粘膜変化について

Mucosal Pattern in Cancer of the Esophagus

　食道癌，とくに扁平上皮癌は主癌巣以外にその標本上，多様性を示すものが多く，従来．食道癌に伴う上皮内癌として記載され，また食道癌は縦軸方向に伸びることが多いということを述べた報告は多い．しかし食道癌の標本を肉眼的に十分吟味し，その随伴病変について類型を見きわめ，組織所見と対比した報告は比較的すくないように思われる．また，これら変化に対して食道癌切除時に払うべき関心とその対策について述べた報告もすくなく，外科臨床上とくに有意義であると考えるので報告する次第である．

Ⅰ．検査材料および方法

　ここに調査対象とした食道癌剔出標本は，1952年から1970年までの食道扁平上皮癌140例である．この調査では，食道癌の主癌巣ではなく，つぎのような“併存する粘膜病変”について肉眼的および病理組織学的に検討した．

　Mutilple cancerous lesions are not infrequently noticed in the specimen of squamous cell carcinoma of the esophagus. However, the relationship between multicentric origin or seperate nodule and intraepithelial carcinoma has not been completely discussed.

　One hundred and forty cases of squamous cell carcinoma of the esophagus have been examined. Intraepithelial carcinoma associated with carcinoma of the esophagus was noted in 31 cases (22.1%). Seventeen cases with multiple cancerous lesions were analyzed. Group 1 (4 cases) has concomitant intraepithelial carcinoma which is very distant from the main tumor. Group 2 (3 cases) has seperate or satellite nodule with concomitant intraepithelial carcinoma. Group 3 (7 cases) has extensive concomitant intraepithelial carcinoma and group 4 (4 cases) has other intramural cancerous lesions (infiltration or embolic metastases from the main tumor). (One case belongs to 2 groups.)

　Detailed observation of groups 1, 2 and a part of 3 led us to assume multicentric origin of primary independent origin of primary independent cancer foci, while group 3 suggested wide cancer focus of unknown origin. So-called pseudosarcoma is considered as one of various changes delivered from intraepithelial carcinoma. Separate or satellite nodule, often developing from it, should be distinguished from infiltration or embolic metastases.

　Some of these mucosal patterns or subepithelial metastases can be recognized by macroscopic observation and through esophagotomy, for accurate resection is the aim of our routine procedure.