胃と腸39巻9号

2004年08月発行

今月の主題 Barrett食道癌―表在癌の境界・深達度診断

主題

Barrett食道の考え方―最近の進歩を踏まえて

著者： 下田忠和¹ 中西幸浩² 阪眞¹ 関根茂樹² 谷口浩和¹

所属機関： ¹国立がんセンター中央病院臨床検査部 ²国立がんセンター中央病院研究所病理部

ページ範囲：P.1211 - P.1222

文献概要

要旨　Barrett食道の診断にはesophagogastric junction（EGJ）の同定が重要であるが，それは困難である．それを解決する方法としては柵状血管の下端を認識することが現時点では最も妥当と考えられる．一方Barrett食道は食道の扁平上皮が円柱上皮で置換された状態であるが，その組織学的特徴は噴門腺粘膜，ならびにそれに杯細胞化生を伴った上皮で基本的には胃の形質を有している．またその発生に関してはいまだ明らかになっていないが，最近になり扁平上皮からの異分化，食道噴門腺の露出，multilayered epitheliumからの分化などが示唆されている．

参考文献

1）Blot WJ, Devesa SS, Kneller RW. Rising incidence of adenocarcinoma of the esophagus and gastric cardia. JAMA 265 : 1287-1289, 1991

2）Blot WJ, Devesa SS, F raumeni JF. Continuing climb in rates of esophageal adenocarcinoma : An update. JAMA 270 : 1320, 1993

3）Pera M, Cameron AJ, Trastek VF, et al. Increasing incidence of adenocarcinoma of the esophagus and esophagocardiac junction. Gastroenterology 104 : 510-513, 1993

4）Okabayashi T, Gotoda T, Kondo H, et al. Early carcinoma of the gastric cardia in Japan. Is it different from that in the West? Cancer 89 : 2555-2559, 2000

5）Tajima Y, Nakanishi Y, Yoshimura K, et al. Clinicopathological study of early adenocarcinoma of the gastric cardia : comparison with early adenocarcinoma of the distal stomach and esophagus. Oncology 61 : 1-9, 2001

6）下田忠和，中西幸浩．胃・食道接合部癌の病理学的特徴．病理と臨床 22 : 586-595, 2004

7）渡辺玄，西倉健，味岡洋一．食道腺癌，胃・食道接合部腺癌にみられる粘液形質の変化．病理と臨床 22 : 596-605, 2004

8）Spechler SJ, Dixon MF, Genta R. Adenocacinoma of the oesophago-gastric junction. In Hamilton SR, Aalotonen LA（ed）. Pathology and Genetics, Tumor of the Digestive Disease. IARC, WHO, Lyon, pp 32-36, 2000

9）Mittal RK. Pathophysiology of gastroesophageal reflux : motility factors. J Gastroenterol 38（suppl 15）: 7-12, 2003

10）田久保海誉，本間尚子，岩切勝彦，他．胃・食道接合部の構造．病理と臨床 22 : 552-556, 2004

11）Spechler SJ, Goyal RK. Barrett's esophagus. N Engl J Med 315 : 362-371, 1986

12）Erkardt VF, Adami B, Hucker H, et al. The esophagogastric junction in patients with asymptomatic lower esophageal mucosal rings. Gastroenterology 79 : 426- 430, 1980

13）MaClave SA, Boyce-HW, Gottfried MR. Early diagnosis of columnar-lined esophagus : a new endoscopic diagnostic criterion. Gastrointest Endosc 33 : 413-416, 1987

14）Chandrasoma PT, Lokuhetty DM, Demeester TR, et al. Difinition of histologic changes in gastroesophageal reflux disease. Am J Surg Pathol 24 : 344-351, 2000

15）Chandrasoma PT, Der R, Ma Y, et al. Histology of the gastroesophageal junction : an autopsy study. Am J Surg Pathol 24 : 402-409, 2000

16）Mori M, Kitagawa S, Iida M, et al. Early carcinoma of teh gastric cardia. A clinicopathologic study of 21 cases. Cancer 59 : 1758-1766, 1987

17）De Carvalho CAF. Sur l architectureveineuse de la zone de transition oesophagogastrique et soninterpretation functionnele. Acta Anat 64 : 125-162, 1966

18）星原芳雄，木暮喬，福地創太郎，他．下部食道縦走血管の内視鏡的観察とその臨床的意義．Gastroenterol Endosc 28 : 941-946, 1986

19）星原芳雄，木暮喬，山本敬，他．short segment Barrett's esophagusの診断．胃と腸 34 : 133-139, 1999

20）Hayward J. The lower end of the esophagus. Thorax 16 : 36-41, 1961

21）Kilgore SP, Ormsby AH, Gramlich TL, et al. The gastric cardia : Fact or fiction？ Am J Gastroenterol 95 : 921-924, 2000

22）Zhou H, Greco MA, Kahn E. Origin of cardiac mucosa : Oncogenic consideration. Pediatric Dev Pathol 4 : 358-363, 2001

23）Bremner CG, Lynch VP, Ellis HF. Barrett's esophagus : Congenital or aquired？ An Experimental study of esophageal mucosal regeneration in the dog. Surgery 68 : 209-216, 1970

24）Sarbia M, Donner A, Gabbert HE. Histology of gastroesophageal junction : A study on 36 operation specimens. Am J Surg Pathol 26 : 1207-1211, 2002

25）小川正純，乾哲也，下田忠和，他．日本人における食道胃接合部の臨床病理学的検討．胃と腸 36 : 625-633, 2001

26）De Nardi FG, Riddell Rh. Esophagus. In Sternbergs SS（ed ）. Histology for Pathologists. Raven Press Ltd, New York, pp 515-532, 1992

27）渡辺英伸，田邊匡，八木一芳，他．食道胃接合部癌の病理学的特徴．胃と腸 36 : 634-650, 2001

28）Paull A, Trier JS, Dalton MD, et al. The histologic spectrum of Barrett's esophagus. N Engl J Med 295 : 476-480, 1976

29）Herlihy KJ, Orlando JC, Bryson EM, et al. Barrett's esophagus : Clinical, endoscopic, histologic, manometric, and electrical potential difference characteristics. Gastroenterolgy 86 : 436-443, 1984

30）Barrett NR. Chronic peptic ulcer of the oesophagus and oesophagitis. Br J Surg 38 : 175-182, 1950

31）Allison PR, Johnstone AS. The esophagus lined with gastric mucous membrane. Thorax 8 : 87-101, 1953

32）Barrett NR. The lower esophagus lined by columnar epithelium. Surgey 41 : 881-894, 1957

33）Tileston W. Peptic ulcer of th esophagus. Am J Med Sci 132 : 240-265, 1906

34）Lyall A. Chronic peptic ulcer of the esophagus, a report of eight cases. Br J Surg 24 : 534-547, 1937

35）Lortat-Jacob JL. L'Endo braeky esophage. Sermauce des Hopotates. Annales de Chir 11 : 1247-1255, 1957

36）Sarvary MM. Diagnosis, pathophysiology and adenocarcinogenesis of Barrett's esophagus. In De Meester TR, et al （eds）. Esophagelal Disorders ; Pathophysiology and Therapy. Raven Press, New York, pp 101-108, 1985

37）Skiner DB, Walther BC, Little AG. Surgical treatment of Barrett's esophagus. In Spechler SJ, et al（eds）. Barrett's Esophagus, Pathopysiology, Diagnosis and Management. Elsevier Sci Pub Co, New York, pp 211-221, 1985

38）Bremmer CG, Hamilton DG. Barrett's esophagus; Contrversial aspects. In De Meester TR, et al（eds）. Esophageal Disorders, Patholophysiology and Therapy. Raven Press, New York, pp 233-239, 1985

39）Takubo K, Sasajima K, Yamashita K, et al. Double muscularis musosa in Barrett's esophagus. Hum Pathol 22 : 1158-1161, 1991

40）Trier JS. Morphology of the epithelium of the distal esophagus in patients with midesophageal pepticd strictures. Gastroenterology 58 : 444-461, 1970

41）Glickman JN, Wang H, Das KM, et al. Phenotype of Barrett's esophagus and intestinal metaplasia of the distal esophagus and gastroesophageal junction. An immunohistochemical study of cytokeratin 7 and 20, Das-1 and 45M1. Am J Surg Pathol 25 : 87-94, 2001

42）Chen YY, Wang HH, Antonioli DA, et al. Significance of acid-mucin-positive nongoblet columnar cells in the dsital esophagus and gastroesophageal junction. Hum Pathol 30 : 1488-1495, 1999

43）Van de Bovenkanp JHB, Korteland-Van Male AM, Warson C, et al. Gastric type mucin and TFF-peptide expression in Barrett's oesopagus in distributed during increased expression of MUC2. Histopathology 42 : 555-565, 2002

44）中村真一，喜納勇，新井富生．Barrett食道の病理組織学的検討―特にspecialized columnar epitheliumについて．胃と腸 25 : 425-432, 1990

45）Ormsby AH, Goldblum JR, Rice TW, et al. Cytokeratin subsets can reliably distinguish Barrett's esophagus from intestinal metaplasia of the stomach. Hum Pathol 30 : 288-294, 1999

46）De Meester SR, Wickramasinghe KS, Lord RV, et al. Cytokeratin and DAS-1 immunostaininig reveal similarityies among cardiac mucosa, CIM, and Barrett's esophagus. Am J Gastroenterol 97 : 2514-2523, 2002

47）Flucke U, Steinboren E, Dries V, et al. Immunoreativity of cytokeratins（CK7, CK20）and mucin peptide coreantigens（MUC1, MUC2, MUC5AC）in adenocarcinomas, normal and metaplastic tissues of the distal oesophagus, oesophago-gastic junction and proximal stomach. Histopathology 43 : 127-134, 2003

48）Mohammed IA, Streutker CJ, Riddle RH, et al. Utilization of cytokeratin 7 and 20 dose not differentiate between Barrett's esophagus and gastric cardiac intestinal metaplasia. Mod Pathol 15 : 611-616, 2002

49）Kurtkaya-Yapicier O, Gencosmanoglu R, Avsar E, et al. The utility of cytokeratins 7 and 20（CK7/20）immunohistochemistry in the distinction of short-segment Barrett esophagus from gastric intestinal metaplasia : Is it reliable？ BMC Clin Pathol 3 : 1-8, 2003

50）Mandys V, Lukas K, Revoltella R. Different patterns of cytokeratin expression in Barrett's esophagus―what is beyond？ Pathol Res Pract 199 : 581-587, 2003

51）佐竹儀治，喜納勇．ヒト胃腸上皮化生の研究―特にgoblet cell metaplasiaについて．胃と腸 17 : 1029-1034, 1982

52）田嶋勇介，下田忠和，中西幸浩，他．Barrett上皮ならびにBarrett腺癌の組織学的・粘液および免疫組織化学的検討．胃と腸 34 : 141-153, 1999

53）Winter C Jr, Spurling TJ, Chobabian SJ, et al. Barrett's esophagus ; a prevalent, occult complication of gasroesophageal reflux disease. Gastroenterology 92 : 118-124, 1987

54）Hamilton SR. Pathogenesis of columnar cell-lined （Barrett's）esophagus. In Spechler SJ, Goyal RK（eds）. Barrett s Esophagus. Elsevier, New York, pp 29-37, 1985

55）Jankowski JA, Wright NA, Meltzer SJ, et al. Molecular evolution of the metaplasia-dysplasia-adenocarcinoma sequence in the esophagus. Am J Pathol 154 : 965-973, 1999

56）Shields HM, Zwas F, Antonioli DA, et al. Detection by scanning electron microscopy of distinctive esophageal surface cell at the junction of squamous and Barrett s epithelium. Dig Dis Sci 39 : 97-108, 1993

57）Glickman JN, Chen YY, Wang HH, et al. Phenotypic characteristics of a distinctive multilayered epithelium suggests that it is a precursor in the development of Barrett's esophagus. Am J Surg Pathol 25 : 569-578, 2001

58）Glickman JN, Yang A, Shahsafei A, et al. Expression of p53-related protein p63 in the gastrointestinal tract and in esophageal metaplastic and neoplastic disorders. Hum Pathol 32 : 1157-1165, 2001

59）Hall PA, Woodman AC, Campbell SJ, et al. Expression of the p53 homologus p63alpha and DeltaNp63 alpha in the neoplastic sequence of Barrett's esophagus: correlation with morphology and p53 protein. Gut 49 : 618-623, 2001

60）Sato T, Miwa K, Sahara H, et al. The sequential model of Barrett's esophagus and adenocarcinma induced duodeno-esophageal reflux without exogenous carcinogens. Anticance Res 22 : 39-44, 2002

61）Kumagai H, Mukaisho K, Hattori T, et al. Cell kinetic study on histogenesis of Barrett's esophagus using rat reflux model. Scand J Gastroenterol 38 : 687-692, 2003

62）神津照雄，坂口文秋，山田英夫，他．Barrett食道の内視鏡診断．胃と腸 25 : 399-406, 1990