| 特集名 | 早期食道癌 -- 病型分類と深達度から | |
|---|---|---|
| 題名 | 早期食道癌の病理 -- 表在癌とリンパ節転移との関係 | |
| 発刊年月 | 1997年 11月 | |
| 著者 | 冨松 久信 | 癌研究所病理部 |
| 著者 | 柳澤 昭夫 | 癌研究所病理部 |
| 【 要旨 】 | 癌研外科で切除された術前無治療の食道粘膜癌33例33病変，粘膜下層癌91例91病変を対象に，リンパ節転移の有無と病理学的諸因子との関係について検討した． (1)癌深達度m2までは脈管侵襲とリンパ節転移は認めなかった(0/22)．深達度m3はリンパ管侵襲，リンパ節転移を認め，その頻度は各々36.4%，18.2%であった．以上から長期生存が期待できる真の早期癌は深達度m2までといえる．また臨床的には内視鏡切除の絶対適応は深達度m2までである．(2)深達度sm1を粘膜筋板から癌の最深部までの距離が200μm以内の微小浸潤癌と定義すると，sm1のリンパ管侵襲率は66.7%，リンパ節転移率は33.3％と高率であった．この結果から，従来用いられているsm層への深達度をsm1~3と3等分する方法でのsm1のリンパ節転移率は，著者らのsm1より高頻度であることが推測され，予後との観点からみると意味のない分類であることを示している．(3)深達度m3・sm1で，リンパ節転移の可能性が高い条件は，癌が基底膜を破り，粘膜固有層に小滴状に浸潤(Droplet infiltration;DI)した像を示したことであった．このDI所見のみられたm3,sm1のリンパ節転移率は36.8％(7/19)であり，DI陰性例はすべてリンパ節転移を認めなかった(0/7)．興味あることは，リンパ管侵襲陰性の2例にリンパ節転移を認めたが，DIは陽性であり，リンパ節転移の判定に重要な組織学的所見と考える．(4)リンパ節転移のない肉眼型の条件は，0-IIb型，0-IIa型基本型，IIa混合型では高さ0.3mm以上ですでにリンパ節転移があり，高さとリンパ節転移との関係は明らかでなかった．0-IIc型では陥凹面が平滑，陥凹境界が不明瞭，辺縁隆起がなく，陥凹の深さが0.2mm以下，色調が淡い褐色調の5条件を満たすものであった． |
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| Theme | Early Esophageal cancer-from the Viewpoint of its Type and the Depth of Invasion | |
|---|---|---|
| Title | Pathology of Early Esophageal Cancer: Relationship between Superficial Cancer and Lymph Node Metastatis | |
| Author | Hisanobu Tomimatsu | Department of Pathology, Cancer Institute |
| Author | Akio Yagisawa | Department of Pathology, Cancer Institute |
| [ Summary ] | The relationship between lymph node metastasis and various pathological factors was studied in 33 patients(33 lesions) with untreated mucosal cancer of the esophagus and 91 patients(91 lesions) with submucosal cancer of the esophagus who underwent resection at the Department of Surgery of the Cancer Institute. (1) With cancer of up to m2 in depth, no vascular invasion or lymph node metastasis was found (0/22). At a depth of m3, however, both lymphatic invasion and lymph node metastasis occurred at frequencies of 36.4% and 18.2%, respectively. From these findings, it appears that early cancer for which long-term survival can be expected should not exceed a depth of m2. Clinically, the absolute indication for endoscopic resection is a depth of invasion not exceeding m2. (2) When sm1 invasion was defined as microinvasive cancer with the distance from the muscularis mucosae to the deepest part of the cancer being under 200microm, the lymphatic invasion rate was 66.7% and the lymph node metastasis rate was 23.5%, both being high. Accordingly, the lymph node metastasis rate of sm1 cancer, as classified according to the conventional classification of submucosal (sm) invasion into three stages (sm1-3), is high based on these results. (3) The features associated with a strong possibility of lymph node metastasis at invasion depths of m3, to sm1 are destruction of the basement membrane by the cancer and the presence of Droplet infiltration (DI) in the lamina propria. The lymph node metastasis rate in m3 or sm1 DI-positive patients was 36.8% (7/19). None of the DI-negative patients had lymph node metastasis (0/7). It is interesting that lymph node metastasis was seen in two patients without lymphatio invasion who were DI-positive, indicating that DI is an important histological finding for assessment of lymph node metastasis. (4) A study of macroscopic features related to the absence of lymph node metastasis showed that it was already present in the 0-IIb, 0-IIa basic and IIa mixed types at heights of 0.3 mm or more and there was no clear relationship between height and lymph node metastasis. In type 0-IIc, five conditions had to be met : a flat depressed surface, an didistinct boundary of the depression, no peripheral protrusion, a depression not more than 0.2 mm deep, and a light brown color. |
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