食道表在浸潤性扁平上皮癌の内視鏡的粘膜下郭清標本の病理学的解析

[Pathological Analysis of Endoscopic Submucosal Dissection Specimen of Esophageal Superficial Infiltrating Squamous Cell Carcinoma].

• Du He
• Dan Jiang
• Tao-Lin Chen
• Wen-Yan Zhang

抄録

目的:

内視鏡的粘膜下郭清標本（ESD）の表在浸潤性扁平上皮癌の病理学的特徴を解析する。

OBJECTIVE: To analyze the pathological characteristics of superficial infiltrating squamous cell carcinoma of endoscopic submucosal dissection (ESD).

方法:

2016年1月31日から2017年12月31日までにESD手術後の浸潤性扁平上皮癌187例を収集した。腫瘍分化、浸潤深さ、浸潤増殖パターン（INF）、腫瘍芽生え、血管リンパ浸潤、マージンを決定した。ESD後の内視鏡生検と外科手術の病理診断を検索した。

METHODS: 187 cases of invasive squamous cell carcinoma after ESD operation were collected from 2016 Jan 31 to 2017 Dec 31. The tumor differentiation, invasion depth, infiltrative growth pattern (INF), tumor budding, angiovascular lymphatic invasion and margin were determined. The pathological diagnosis of endoscopic biopsy and surgical operation after ESD were searched.

結果:

患者の年齢は42～83歳で、男性147名、女性40名であった。9.1％の患者が他部位に癌・上皮内新生物を有していたが、その中で胃腺癌が最も多かった。扁平上皮癌は良性、中等度、低分化型がそれぞれ0.5％、41.7％、15.0％であり、残りの42.8％は微小浸潤であり、悪性度判定が困難であった。粘膜前葉lamina propriaが39.6％、筋状粘膜が32.6％、粘膜下浸潤が27.8％であった。粘膜下浸潤＜200μm（SM1）が9.1％、粘膜下浸潤≧200μm（SM2）が18.7％であった。リンパ管浸潤は、腫瘍浸潤の深さ、腫瘍芽生え、INFと関連していた。リンパ管浸潤率は、浸潤深さの増加と腫瘍芽出しのグレードの増加に伴って増加した。INFb/c群のリンパ管浸潤率はINFa群よりも高かった。また、リンパ管浸潤の発生率には、分化度の高い/中等度の扁平上皮癌と分化度の低い扁平上皮癌との間に統計的な差はなかった。多変量解析の結果、腫瘍の芽生えがリンパ管浸潤の独立した危険因子であることが示された。完全切除例は69.5％（130例）を占めたが、不完全切除例（57例）のほとんどは低悪性度上皮内新生物が関与していた。ESD後に生検を受けた症例は69例で、そのうち再発なしが46例（66.67％）、再発ありが19例（27.54％）、その他の部位に発生した症例が4例（5.80％）であった。完全切除（28.3％、13/46）と不完全切除（31.6％、6/19、＞0.05）では再発率に統計学的差はなかった。

RESULTS: The patients were aged from 42 to 83 years old, including 147 males and 40 females. 9.1% patients had carcinoma/intraepithelial neoplasia in other sites, among which gastric adenocarcinoma was the most common one. Well, moderately and poorly differentiated squamous cell carcinoma accounted for 0.5%, 41.7% and 15.0%, respectively, while the remaining 42.8% cases were microinvasion and were difficult to be graded. Mucosa lamina propria, muscularis mucosa and submucosa invasion accounted for 39.6%, 32.6% and 27.8%, respectively. Submucosa infiltration <200 μm (SM1) accounted for 9.1% and submucosa infiltration ≥200 μm (SM2) accounted for 18.7%. Lymphatic vessel invasion was related to the depth of tumor invasion, tumor budding, INF. The invasion rate of lymphatic vessels increased with the increase of infiltration depth and the grade of tumor budding. The lymphatic invasion rate in INFb/c group was higher than that in INFa group. There was no statistical difference in the incidence of lymphatic vessel invasion between well/moderately differentiated squamous cell carcinoma and poorly differentiated squamous cell carcinoma. Multivariate analysis showed that tumor budding was an independent risk factor for lymphatic vessel invasion. The complete resection occupied 69.5% (130 cases), while most of incomplete resection cases (57 cases) were involved by low-grade intraepithelial neoplasia. 69 cases had biopsy after ESD, among which there were 46 cases (66.67%) with no recurrence, 19 cases (27.54%) with recurrence, and 4 cases (5.80%) occurring in other sites. There was no statistical difference in recurrent rate between the complete resection (28.3%, 13/46) and the incomplete resection (31.6%, 6/19, >0.05).

結論:

ESD検体の病理学的報告では、腫瘍浸潤深さ、INF、腫瘍芽出し、リンパ管浸潤のすべてを開示すべきである。腫瘍萌出はリンパ管浸潤の独立した危険因子であった。

CONCLUSIONS: Tumor invasion depth, INF, tumor budding andlymphatic vessel invasion should all be disclosed for the ESD specimen pathological report. Tumor budding was an independent risk factor for lymphatic vessel invasion.

Copyright© by Editorial Board of Journal of Sichuan University (Medical Science Edition).