Tsuji Naoko, Ishiguro Shingo, Tsukamoto Yoshitane, Mano Masayuki, Kasugai Tsutomu, Miyashiro Isao, Doki Yuichiro, Iishi Hiroyasu, Kudo Masatoshi
Department of Pathology, Osaka Medical Center for Cancer and Cardiovascular Diseases, 1-3-3 Nakamichi, Higashinari-ku, Osaka 537-8511, Japan.
Gastric Cancer. 2004;7(2):97-103. doi: 10.1007/s10120-004-0275-6.
In the West, the incidence of adenocarcinoma of the cardia or esophagogastric junction (EGJ) is increasing. This carcinoma is variously defined, however, and it contains heterogeneous tumors. In Japan, the frequency of this carcinoma is low, and little is known about it. We studied small esophagogastric junctional adenocarcinoma to determine its characteristics in Japanese patients.
Fifty-four patients with Siewert type II junctional adenocarcinoma (with tumors <<4 cm in maximum diameter) were studied. The carcinomas were classified into two types: tumors straddling the EGJ (EGJ-type) and tumors occurring entirely below the EGJ (bEGJ-type). Characteristics of the tumors and surrounding mucosae were evaluated. Phenotypic expression of mucin, p53 overexpression, and Helicobacter pylori infection were investigated histologically and immunohistochemically.
Twenty-three (43%) patients had EGJ-type and 31 (57%) had bEGJ-type carcinomas. The ratio of advanced cancers was significantly higher in EGJ-type. Some between-group similarities and differences existed in histological type, mucin phenotype, and p53 protein overexpression, but they were not statistically significant. In the mucosa surrounding EGJ-type tumors vs bEGJ-type tumors, oxyntic glands were significantly better preserved, gastric intestinal metaplasia occurred significantly less frequently, and the H. pylori infection rate was lower. Barrett's metaplasia was seen in only 2 patients, with the EGJ-type.
EGJ-type and bEGJ-type adenocarcinomas have different background mucosa of the stomach. EGJ-type has less atrophy of the oxyntic glands and less intestinal metaplasia in the stomach. This type appears to be the Western-type junctional adenocarcinoma that is still rare in Japan. Many cases of advanced junctional adenocarcinoma in Japan are of subjunctional origin.
在西方，贲门或食管胃交界部（EGJ）腺癌的发病率正在上升。然而，这种癌症的定义各不相同，且包含异质性肿瘤。在日本，这种癌症的发病率较低，人们对其了解甚少。我们研究了小的食管胃交界部腺癌，以确定其在日本患者中的特征。
对54例Siewert II型交界部腺癌（最大直径<<4 cm的肿瘤）患者进行了研究。这些癌症被分为两种类型：跨越EGJ的肿瘤（EGJ型）和完全发生在EGJ下方的肿瘤（bEGJ型）。评估了肿瘤及周围黏膜的特征。通过组织学和免疫组织化学方法研究了黏蛋白的表型表达、p53过表达和幽门螺杆菌感染情况。
23例（43%）患者为EGJ型癌，31例（57%）为bEGJ型癌。EGJ型中进展期癌症的比例显著更高。在组织学类型、黏蛋白表型和p53蛋白过表达方面存在一些组间异同，但无统计学意义。与bEGJ型肿瘤相比，EGJ型肿瘤周围黏膜中的泌酸腺保存明显更好，胃黏膜肠化生发生率明显更低，幽门螺杆菌感染率也更低。仅2例EGJ型患者出现了巴雷特化生。
EGJ型和bEGJ型腺癌的胃背景黏膜不同。EGJ型的泌酸腺萎缩较少，胃黏膜肠化生也较少。这种类型似乎是西方型交界部腺癌，在日本仍然罕见。日本许多进展期交界部腺癌病例起源于交界部下。
