Institute of Pathology, Klinikum Bayreuth, Bayreuth, Germany.
Pathol Res Pract. 2010 May 15;206(5):300-4. doi: 10.1016/j.prp.2010.01.005. Epub 2010 Feb 25.
The differential diagnosis "high-grade intraepithelial neoplasia" or "well-differentiated Barrett's adenocarcinoma limited to the mucosa" is controversial. We investigated 277 endoscopically resected specimens of early Barrett's carcinoma. Depth of infiltration was classified as follows: m 1=carcinoma limited to Barrett's mucosa; m 2=carcinoma infiltrating the neo-muscularis mucosae; m 3=infiltration of the original lamina propria of the esophageal mucosa; m 4=infiltration of the original muscularis mucosae; sm 1, sm 2, and sm 3=infiltration into the upper third, middle third, and lower third of the submucosa. The pattern of invasion was classified and graded as follows: tubular (D 0)=only neoplastic tubuli showing cytologic criteria of malignancy - no tumor cell dissociation; dissociation grade 1 (D 1)=few dissociated tumor cells; D 2=moderate amount of dissociated tumor cells; D 3=pronounced tumor cell dissociation. 74-96% of m 1-m 4 Barrett's carcinomas limited to the mucosa have a D 0-pattern. Tubular invasion decreases only when the submucosa has been infiltrated (sm 1: 70.4%, sm 2: 30.0%, sm 3: 24.0%). Our study shows that the pattern of invasion in early cancer in Barrett's esophagus statistically significantly depends on depth of infiltration.
“高级别上皮内瘤变”或“局限于黏膜的高分化 Barrett 腺癌”的鉴别诊断存在争议。我们研究了 277 例经内镜切除的早期 Barrett 癌标本。浸润深度分类如下：m1=局限于 Barrett 黏膜的癌；m2=浸润至新生黏膜肌层的癌；m3=浸润食管固有黏膜的原始黏膜下层；m4=浸润固有肌层；sm1、sm2 和 sm3=浸润黏膜下层的上 1/3、中 1/3 和下 1/3。浸润模式分为以下几类并分级：管状（D0）=仅出现具有恶性细胞学标准的肿瘤小管-无肿瘤细胞分离；分离度 1 级（D1）=少量分离的肿瘤细胞；D2=中等量分离的肿瘤细胞；D3=明显的肿瘤细胞分离。74%-96%的局限于黏膜的 m1-m4 Barrett 癌为 D0 型。只有当黏膜下层被浸润时，管状浸润才会减少（sm1：70.4%，sm2：30.0%，sm3：24.0%）。我们的研究表明，Barrett 食管早期癌的浸润模式在统计学上显著依赖于浸润深度。
