| 抄録 |
The incidence of Barrett's adenocarcinoma(BEA) have been gradually increasing also in Japan, however, almost BA arises in short segment of BE(SSBE). SSBE adenocarcinoma is often hard to differential diagnosis from gastric cardiac adenocarcinoma(GCA),because the determination of esophageal gastric junction (EGJ) is difficult. Macroscopically, EGJ almost corresponds to narrowing portion from cystic stomach to esophagus. Gross feature of superficial BEA is shows elevated or shallow depressed type nearly IIb with unclear margin. Histologically, differentiated type, which shows gastric phenotype immunoistochemically, is high incidence(95%) and undifferentiated type is very rare. However, poorly differentiated component and lymphatic permeation of tumor cells is detected in invasive area and incidence of lymph node metastasis is higher than gastric cancer. The histological grade of differentiated carcinoma is low grade atypia. The low grade atypia of cancer is most of reason for uncler tumor margin macroscopically and endoscopically. Intestinal (goblet) cell metaplasia of BE is shown in 40% and the other shows gastric cardiac gland type mucosa. In superficial BEA near the squamocolumnar junction, carcinoma often spreads to subsquamous epithelium and the length of tumor spreading is 1-2cm. This spreading type is one of the reason of unclear margin of BEA. |
