Kumagai Y, Inoue H, Nagai K, Kawano T, Iwai T
First Department of Surgery, Tokyo Medical and Dental University School of Medicine, Japan.
Endoscopy. 2002 May;34(5):369-75. doi: 10.1055/s-2002-25285.
In this study we clarify the microvascular architecture of superficial esophageal carcinoma as observed by ultra-high magnification endoscopy and stereoscopic microscopy with Microfil injection.
We observed two surgically resected specimens of superficial esophageal cancer under stereoscopic microscopy with Microfil injection. In addition, in the histological investigation, we measured the caliber of the vessels at the surface of the tumor. We carried out ultra-high magnification before treatment in 82 patients with superficial esophageal neoplasms. We classified the depth of tumor penetration of superficial esophageal carcinoma into four categories: m1 to m3 (mucosal cancer) and sm (submucosal cancer).
By observing the normal esophageal mucosa under a stereoscopic microscope and an ultra-high magnification endoscope, we were able to visualize the intrapapillary capillary loops (IPCL). In cancer lesions, we observed characteristic changes in the superficial microvascular architecture according to the depth of tumor invasion. In m1 invasion, there was dilatation of the IPCL; in m2 invasion, there was dilatation and elongation of the IPCL; in m3, there was a mixed appearance of the IPCL and tumor vessels; and in sm invasion, complete replacement by tumor vessels. On the basis of the above criteria, ultra-high magnification endoscopic observation before treatment showed a rate of agreement between histological depth of invasion and magnified appearance of 60/72 cases (83.3 %) for which satisfactory pictures were obtained. The histological investigation showed the caliber of the IPCL of the m1 cancer lesions (12.9 +/- 3.9 microm) to be significantly greater than that of the normal esophageal mucosa (6.9 +/- 1.5 microm) (P < 0.0001).
Observation of the microvascular architecture of superficial esophageal carcinoma is useful in the diagnosis of the depth of invasion.
在本研究中，我们通过超高倍放大内镜及使用微管灌注的立体显微镜观察，阐明浅表食管癌的微血管结构。
我们对两个经手术切除的浅表食管癌标本进行了微管灌注后的立体显微镜观察。此外，在组织学研究中，我们测量了肿瘤表面血管的口径。我们对82例浅表食管肿瘤患者在治疗前进行了超高倍放大观察。我们将浅表食管癌的肿瘤浸润深度分为四类：m1至m3（黏膜癌）和sm（黏膜下癌）。
通过立体显微镜和超高倍放大内镜观察正常食管黏膜，我们能够观察到乳头内毛细血管袢（IPCL）。在癌灶中，根据肿瘤浸润深度，我们观察到浅表微血管结构有特征性变化。在m1浸润时，IPCL扩张；在m2浸润时，IPCL扩张且延长；在m3时，IPCL与肿瘤血管混合出现；在sm浸润时，完全被肿瘤血管取代。根据上述标准，治疗前超高倍放大内镜观察显示，在获得满意图像的72例病例中有60例（83.3%）组织学浸润深度与放大外观的符合率。组织学研究显示，m1癌灶的IPCL口径（12.9±3.9微米）显著大于正常食管黏膜（6.9±1.5微米）（P<0.0001）。
观察浅表食管癌的微血管结构有助于浸润深度的诊断。
