胃と腸40巻3号

2005年03月発行

今月の主題 特殊組織型の食道癌

主題

特殊組織型食道癌の病理組織学的・免疫組織学的特徴

著者： 八尾隆史¹ 神代由美子¹ 平橋美奈子¹ 中村典資¹ 高木靖寛² 岩下明徳² 大城由美³ 川野豊一⁴ 恒吉正澄¹

所属機関： ¹九州大学大学院医学研究院形態機能病理 ²福岡大学筑紫病院病理部 ³松山赤十字病院病理 ⁴防府消化器病センター

ページ範囲：P.288 - P.300

文献概要

要旨　特殊組織型の食道癌18例（小細胞癌5例，カルチノイド1例，類基底細胞-扁平上皮癌8例，腺扁平上皮癌4例）においてそれらの病理組織学的・免疫組織学的特徴を検討し，類基底細胞-扁平上皮癌と腺様嚢胞癌との鑑別困難1例と非小細胞型未分化癌10例について免疫組織学的所見を加味した再分類を試みた．免疫組織学的に，小細胞癌はケラチンでは高分子(－)，低分子(＋)であり，chromogranin Aは必ずしも陽性でなくCD56が最も有用であった．類基底細胞-扁平上皮癌ではケラチンでは高分子(＋)に加えて，様々な割合でCEA，アクチン，vimentin(＋)とbcl-2(＋)が特徴的であり，多分化能を有する腫瘍であることが示された．腺扁平上皮癌は，腺癌と扁平上皮癌のそれぞれに対応した染色性であった．すべての症例において腺様嚢胞様構造部でさえもS-100は陰性であり，腺様嚢胞癌に合致する症例はみられなかった．鑑別診断には病理組織学的所見が最も重要であることは言うまでもないが，非小細胞型未分化癌や鑑別が困難であった例でも免疫組織学的所見を加味するとある組織型へ分類することができ，免疫組織学的所見の有用性が示された．

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