早期食管癌IPCL分型

INTRODUCTIONInthissession,theimpactofanewmagnificationendoscopyinthediagnosisofesophagealandgastriclesionsisdiscussed.DevelopmentofanewmagnificationendoscopySofar,manystudiesutilizingmagnificationendoscopyhavebeenreported,butsomelimitationshaveexistedtotheroutineuseofit.Oldermagnifyingendoscopeshadalargerdiameter,andwererelativelydifficultforinsertionthroughthepharynx,andthereforemagnifyingendoscopyactuallybecameanadditionalstudytotheroutineendoscopicex-amination.Anewmagnifyingendoscope(Q240Z,OlympusOpticalCo.,Tokyo,Japan)keepsthesamesizeinscopediameterapproximatelytoascreeningendoscope(Q240,Olympus).ItalsomountsahighresolutionCCDtipsametoaroutineendoscopeanditalsohasa80¥magnifyingpower.Inotherwords,anendoscopistcanuseanewmagni-fyingendoscopeasaroutinescreeningendoscopyifamagni-fyingobservationofthelesionisnotnecessary.MagnificationendoscopicfindingsintheesophageallesionIntheesophagus,magnificationendoscopyfacilitateswell,bothtothediagnosisofthenegativelystainedlesionwithiodineandtotheevaluationofinfiltrationdepthofsquamouscellcarcinoma.Insquamousepitheliummagnifi-cation,endoscopyrevealschangesoffinevascularnetworkpatternonthemucosaandsubmucosa.Regularlyarrangedintrapapillarycapillaryloops(IPCL)arenormallyobservedbyutilizingmagnificationendoscopy(Fig.1).IPCLshowscharacteristicchangesincarcinomainsitu.Thoseincludeweaving,dilatation,irregularcaliberandadifferentshapeineachIPCL.AccordingtothegradeofIPCLchanges,targetepitheliumcanbediagnosedfromnormalmucosa(TypeI)tocarcinoma(TypeV)(Fig.2).BytheevaluationofIPCLchanges,infiltrationdepthofthecancerouslesioncanalsobeassessed.Inthem1lesion,characteristicchangesinareobserved(Fig.2).Inthem2lesiontheelongationofaffectedIPCLisobserved,andinthem3lesiondestructionofIPCLbecomesmuchmoreobvious.Inthesmcancer,almosttotalIPCLhasbeendestructedandanoveltumorvesseloftenappears(Fig.3).Intheesophagus,theusefulnessofmagnify-ingendoscopyisgraduallybutsteadilyrecognized.DigestiveEndoscopy(2001)13(Suppl.),S40–S41SESSION2:MODERATOR’SCOMMENTMAGNIFICATIONENDOSCOPYINTHEESOPHAGUSANDSTOMACHHaruhiroInoueShowaUniversity,NorthernYokohamaHospital,Yokohama,JapanCorrespondence:HaruhiroInoue,AssistantProfessorChiefofUpperGastrointestinalEndoscopyandSurgery,ShowaUniversity,NorthernYokohamaHospital,Chuo35-1,Tsuzuki-ku,Yokohama224-2503,Japan.Email:haru.inoue@med.showa-u.ac.jpFig.1.Aschematicrepresentationofthevascularnetworkofesophagealmucosa.(a)Submucosaldrainagevein;(b)arborescentvessel;(c)intrapapillarycapilaryloop.Fig.2.Classificationofintrapapillarycapillaryloop(IPCL)pattern.TypeI,positivelystainedwithiodine;IPCLnodifferentfromnormalpattern.TypeII,positivelystainedwithiodine;IPCLhaveoneortwooutoffourcharacteristicchanges,andelongationand/ordilatationiscommonlyseen.often.TypeIII,negativelystainedwithiodine;IPCLhavenochangesorminimalchanges.TypeIV,negativelystainedwithiodine;IPCLhavethreeoutoffourcharacteristicchangesdescribedinTypeV.TypeV;negativelystainedwithiodine;IPCLhaveallfourcharacteristicchangesindicatingcarcinoma-in-situ:dilatation,torturousrunning,caliberchangesanddifferentshapesineachIPCL.MagnificationendoscopyinthestomachYaoandOishi1firstpresentedabasichistologicaspectofmagnifyingendoscopyinthestomach,andthenclarifiedMAGNIFICATIONENDOSCOPYINTHEESOPHAGUSANDSTOMACHS41awell-demarcatedareawithlossofsuperficialcapillarynetworkanddisappearanceofnormalpitsstructure.UndifferentiatedadenocarcinomaInthemucosallesionwithnoulceration(por,sig),magnifica-tionendoscopyshowedareduceddensityofsubepithelialcapillarynetworkdependingonthethicknessofthecarci-nomacellsinthelaminapropriamucosa.Undifferentiatedtypecancercellsofteninvadethedeeperlayerwithnodestructionofthesurfaceepithelium.Yagi2presentedhisrecentdataregardingtoHelicobacterpylori(HP)infectionandmagnifictionendoscopicfindings.MagnificationendoscopicfindingsinthegastricbodyareclassifiedintoZ-0toZ-3.Z-0meansaregulararrangementofcollectingvenules,whichcorrespondswelltothehelicobacternegativemucosawithmorethan90%accuracy.ThesefindingsarevaluableadvancementsinthediagnosisofHPinfection.Inthestomach,magnifyingfindingsaregenerallymorecomplicatedthanthoseintheesophagus.Thestomachdisplaysmanycharacteristicfeatures.Therearethreedifferenttypesofglands,gastritis,mucosalatrophy,HPinfection,intestinalmetaplasia,benignulceration,ulcerscar,differentiatedorundifferentiatedtypeadenocarcinoma,andothers.Allthosethemeswillbeclarifiedinthenearfuture.REFERENCES1.YaoK,OishiT.Microgastroscopicfindingsofmucosalmicrovasculararchitectureasvisualizedbymagnifyingendo-scopy.Dig.Endosc.2001;13(Suppl.):S27–33.2.YagiK.EndoscopicfeaturesandmagnifiedviewsofthecorpusintheHelicobacterpylori-negativestomach.Dig.Endosc.2001;13(Suppl.):S34–5.Fig.3.Changesinanintrapapillarycapillaryloop(IPCL),accordingtotheinfiltrationdepthofT1esophagealcancer.m1,CharacteristicIPCLchangestointraepithelialcarcinoma(TypeVchanges)onlyaffectthetopofIPCL.m2,TypeVchangesaffectthemiddlepartoftheIPCL,andareobservedasanelon-gationoftheaffectedIPCL.m3,TypeVchangesaffectthetotallengthofIPCLandtheoriginalshapeoftheIPCLhasbeendestroyed.sm,Abnormaltumorvesselswithlargediametershaveappeared.thefollowingfindingsmainlybasedonthemicrovascularstructures.DifferentiatedtypeadenocarcinomaDyeenhancementisusefulinthediagnosisofadifferentiatedadenocarcinoma.Differntiatedadnocarcinomaoftenhas