胃と腸47巻9号

2012年08月発行

今月の主題 食道癌の発育進展─初期浸潤の病態と診断 主題研究

血管新生の見地からみた食道癌の発育進展

著者： 熊谷洋一¹ 戸井雅和² 石畝亨¹ 川田研郎³ 石田秀行¹ 河野辰幸³

所属機関： ¹埼玉医科大学総合医療センター消化管・一般外科 ²京都大学乳腺外科 ³東京医科歯科大学食道・一般外科

ページ範囲：P.1428 - P.1434

要旨　NBI拡大内視鏡で観察される食道病変の微細血管形態の変化を血管新生の見地から文献的に考察した．食道における血管新生の第1のスイッチは，前癌病変よりONになる．食道炎，異型上皮，T1a-EP，T1a-LPM食道癌の血管像は“拡張延長した既存のIPCLと新たに誘導されたIPCL様の幼弱血管の集合（IPCL様異常血管）”であり，その血管形態は典型像はあるものの明瞭な境界は認めない．T1a-MM食道癌以深でみられる血管形態は，いわゆる“腫瘍血管”の条件を満たす（新生血管）．主要な血管新生因子も粘膜下層癌で強発現するものが多く，この時点で血管新生の第2のスイッチが入ると考えられ，食道癌発癌初期に多段階の血管新生が起こっている．

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