胃と腸56巻2号

2021年02月発行

今月の主題 Barrett食道腺癌の内視鏡診断と治療2021

主題

Barrett食道腺癌の病理学的特徴—SSBE由来Barrett食道腺癌の特徴

著者： 向所賢一¹ 仲山貴永¹ 九嶋亮治¹

所属機関： ¹1）滋賀医科大学医学部病理学講座

ページ範囲：P.139 - P.144

文献概要

要旨●本邦に多くみられるSSBEは，病理組織学的に胃噴門腺粘膜（cardiac mucosa）が多い．cardiac mucosaの上皮成分は，粘膜表層を覆うMUC5AC陽性の腺窩上皮と，深部に存在するMUC6陽性の噴門腺により構成されている．噴門腺が存在する領域は，胎生期では非常に狭く，後天的に拡がると考えられ，Helicobacter pylori陽性患者では肛門側に，GERD患者では口側に拡がる．SSBEに発生したBarrett食道腺癌の早期病変内には，cardiac mucosaと同様の細胞分布（MUC5AC陽性細胞が管腔側，MUC6陽性細胞が深部）を呈する異型腺管が確認できることが多いため，SSBE由来Barrett食道腺癌はcardiac mucosaから発生したことが示唆される．SSBE由来Barrett食道腺癌は下部食道の右側の前壁（0〜3時方向）に認められることが多く，肉眼型では隆起型が多いと報告されている．また，SSBEはLSBEと同様に悪性腫瘍の発生母地となりうるが，LSBEよりは発癌リスクは低く，同時多発癌や異時多発癌が発生する可能性も非常に低い．

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