胃と腸46巻12号

2011年11月発行

今月の主題 Barrett食道癌の診断 主題

Barrett食道の病理組織学的定義

著者： 渡辺玄¹ 味岡洋一¹

所属機関： ¹新潟大学大学院医歯学総合研究科分子・診断病理学分野

ページ範囲：P.1750 - P.1761

要旨　Barrett食道は，正常状態では一致している食道胃接合部（EGJ）と扁平上皮円柱上皮接合部（SCJ）とが乖離（SCJが口側に移動）し，これらの間が円柱上皮粘膜で被覆された状態である．SCJの同定は容易であるが，固有筋層もしくは柵状血管で定義されるEGJを病理組織学的に決定するのは困難である．食道であることの指標（食道腺，食道腺導管，扁平上皮島，粘膜筋板の二重化）と参考所見（扁平上皮化生様変化，噴門腺粘膜，胃底腺粘膜の分布）とを総合的に判断し，EGJが存在し得る領域を狭めていき，真のEGJに近づけてゆく必要がある．接合部癌の病理診断ではSCJの肛門側に上述した食道の指標が確認できるか否かが重要であるが，病理組織診断の限界を知り臨床所見を合わせた総合的な診断が望まれる．

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