胃と腸44巻7号

2009年06月発行

今月の主題 食道胃接合部腺癌の診断 主題

食道胃接合部腺癌の病理学的特性

著者： 下田忠和¹ 九嶋亮二² 瀧沢初³

所属機関： ¹国立がんセンターがん対策情報センター多施設臨床試験・診療支援部 ²国立がんセンター中央病院臨床検査部 ³国立がんセンター中央病院内視鏡診断部

ページ範囲：P.1083 - P.1094

要旨　食道胃接合部癌を理解するには接合部の病理組織学的特徴を理解する必要がある．従来，筆者らが報告してきた噴門腺には胃と食道噴門腺があり，後者は食道扁平上皮下の粘膜固有層にみられBarrett食道発生との関連がある．またこの食道噴門腺は時に扁平上皮を破って表層に露出することがある．この状態では細胞増殖活性が出現し発癌の母地となりうる．さらに扁平上皮から直接発生する腺癌がある可能性を指摘した．しかしEGJ腺癌の発生母地として最も重要なのはBarrett食道であるが，本邦ではいまだ胃噴門粘膜に発生する腺癌とその食道進展が主である．また腸上皮化生に関連した癌と関連しない癌があるが，それよりは持続性のGERDが発癌要因として極めて重要である可能性を指摘した．

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