特集名 | 消化管粘膜下腫瘍 -- 診断の進歩と治療方針 | |
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題名 | 食道粘膜下腫瘍 (1) 診断 | |
発刊年月 | 2001年 03月 | |
著者 | 小山 恒男 | 佐久総合病院内科 |
著者 | 宮田 佳典 | 佐久総合病院内科 |
著者 | 友利 彰寿 | 佐久総合病院内科 |
著者 | 堀田 欣一 | 佐久総合病院内科 |
著者 | 島谷 茂樹 | 佐久総合病院内科 |
著者 | 都甲 昭彦 | 佐久総合病院外科 |
【 要旨 】 | 食道粘膜下腫瘍には特徴的な肉眼所見があるため,X線,内視鏡,超音波内視鏡を総合的に判断する必要がある.また,病変が大きい場合にはCT,MRIも有効である. 超音波内視鏡や,IDUSはきわめて有用な情報を与えてくれるが,良い画像を得るには食道腔に脱気水を充満することが重要である.オーバーチューブに装着可能なバルーンを用いると誤嚥を予防することが可能で,良い超音波画像を得ることができる. われわれが開発した内視鏡的粘膜下腫瘍核出術(endoscopic scraping enucleation;ESE)は粘膜下腫瘍の確定診断,治療に有効な手技である. |
Theme | Gastrointesinal Submucosal Tumor -- Advances in the Diagnosis and Treatment | |
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Title | Diagnosis of Esophageal Submucosal Tumors | |
Author | Tsuneo Oyama | Department of Gastroenterology, Saku Central Hospital |
Author | Yoshinori Miyata | Department of Gastroenterology, Saku Central Hospital |
Author | Akihisa Tomori | Department of Gastroenterology, Saku Central Hospital |
Author | Kin-ichi Hotta | Department of Gastroenterology, Saku Central Hospital |
Author | Shigeki Shimaya | Department of Gastroenterology, Saku Central Hospital |
Author | Akihiko Togou | Department of Surgery, Saku Central Hospital |
[ Summary ] | Esophagography, esophagoscopy and miniature probes are useful for the diagnosis of a small esophageal submucosal tumors (SMT). CT and MRI are useful for the diagnosis of a large esophageal SMT. Esophagography and esophagoscopy reveal hard, smooth submucosal tumors. Endoscopic ultrasonography (EUS) reveals hypo-echoic mass lesions. Leiomyomas derived from the muscularis mucosae or the submucosal layer grow toward the esophageal lumen. And they derived from the proper muscular layer reveal intra-luminal or extramural growth. The characteristic macroscopic findings for leiomyosarcoma are a large SMT, 5cm or over in size, which is irregular in shape. Differential diagnosis between leiomyoma and leiomyosarcoma is sometimes difficult, because biopsies are difficult to do. EUS reveals a mosaic pattern and invasive growth. A gastro-intestinal stromal tumor (GIST) is rare in the esophagus. The characteristic macroscopic findings of GIST and differential diagnosis between GIST and leiomyoma are unknown. Lipoma and lymphangioma display soft SMT. EUS is very useful for the differential diagnosis between them, because lipoma displays hyper-echoic masses, and lymphangioma reveals hypo-echoic mass lesions. The granular cell tumors reveal a characteristic tooth like yellowish SMT. EUS reveals hypo-echoic solid mass lesions in the second low-echo or third hyper-echoic layer. The most important thing for differential diagnosis of a esophageal SMT is knowing the macroscopically and ultrasonographically characteristic features of SMT. |