胃と腸57巻3号

2022年03月発行

今月の主題 食道上皮内腫瘍の診断と取り扱い

主題

食道上皮内腫瘍とsquamous dysplasia（WHO分類）との関連性

著者： 藤井誠志¹

所属機関： ¹横浜市立大学大学院医学研究科・医学部分子病理学

ページ範囲：P.251 - P.261

文献概要

要旨●2019年に改訂された第5版の「WHO Classification of Tumours：Digestive System Tumours」では，食道扁平上皮の腫瘍性病変をdysplasiaと表記することになった．第4版のWHO分類で用いられていたintraepithelial neoplasiaとの違いは，細胞異型度が重視されることになった点である．本邦で長らく認識されていた表層分化型上皮内扁平上皮癌や基底層置換型上皮内扁平上皮癌と呼称される腫瘍性病変は，WHO分類第4版の基準ではlow-grade intraepithelial neoplasiaに分類されていたが，WHO分類第5版ではhigh-grade squamous dysplasiaに相当する病変に分類が変更された．加えてhigh-grade squamous dysplasiaは，本邦やアジアではcarcinoma in situを含むと明確に定義された．

参考文献

1）The WHO Classification of Tumours Editorial Board（eds）. WHO Classification of Tumours, Digestive System Tumours, 5th ed. IARC press, Lyon, 2019

2）Bosman FT, Carneiro F, Hruban RH, et al（eds）. World Health Organization Classification of Tumours of the Digestive System, 4th ed. IARC press, Lyon, 2010

3）Gao H, Wang LD, Zhou Q, et al. p53 tumor suppressor gene mutation in early esophageal precancerous lesions and carcinoma among high-risk populations in Henan, China. Cancer Res　54：4342-4346, 1994

4）Nie Y, Liao J, Zhao X, et al. Detection of multiple gene hypermethylation in the development of esophageal squamous cell carcinoma. Carcinogenesis　23：1713-1720, 2002

5）Roth MJ, Abnet CC, Hu N, et al. p16, MGMT, RARbeta2, CLDN3, CRBP and MT1G gene methylation in esophageal squamous cell carcinoma and its precursor lesions. Oncol Rep　15：1591-1597, 2006

6）Ishii T, Murakami J, Notohara K, et al. Oesophageal squamous cell carcinoma may develop within a background of accumulating DNA methylation in normal and dysplastic mucosa. Gut　56：13-19, 2007

7）Adams L, Roth MJ, Abnet CC, et al. Promoter methylation in cytology specimens as an early detection marker for esophageal squamous dysplasia and early esophageal squamous cell carcinoma. Cancer Prev Res（Phila）　1：357-361, 2008

8）Muto M, Hironaka S, Nakane M, et al. Association of multiple Lugol-voiding lesions with synchronous and metachronous esophageal squamous cell carcinoma in patients with head and neck cancer. Gastrointest Endosc　56：517-521, 2002

9）Dawsey SM, Lewin KJ, Wang GQ, et al. Squamous esophageal histology and subsequent risk of squamous cell carcinoma of the esophagus. A prospective follow-up study from Linxian, China. Cancer　74：1686-1692, 1994

10）Wang GQ, Abnet CC, Shen Q, et al. Histological precursors of oesophageal squamous cell carcinoma：results from a 13 year prospective follow up study in a high risk population. Gut　54：187-192, 2005

11）Lam AK, Bourke MJ, Chen R, et al. Dataset for the reporting of carcinoma of the esophagus in resection specimens：recommendations from the International Collaboration on Cancer Reporting. Hum Pathol　114：54-65, 2021

12）Fujii S, Lam AK. Macroscopic assessment and sampling of endoscopic resection specimens for squamous epithelial malignancies with superficial involvement of esophagus. Methods Mol Biol　2129：63-81, 2020