Lam K Y, Ma L T, Wong J
Department of Pathology, University of Hong Kong.
J Clin Pathol. 1996 Feb;49(2):124-9. doi: 10.1136/jcp.49.2.124.
(1) To examine the prevalence and extent of intramural metastasis in squamous cell carcinomas of the oesophagus so as to delineate the resection margins for these tumours; (2) to devise an appropriate method for measurement of these lesions which takes into account of the contraction of the specimens after resection.
Oesophagectomy specimens were prospectively collected from 96 patients (87 males, nine females) with primary oesophageal squamous cell carcinoma over a two year period. The sizes of the tumours were measured in situ, after resection and after application of muscle relaxant (to regain their in situ length). The specimens were then serially sectioned for histological examination.
The sizes of the tumours measured after application of muscle relaxant roughly corresponded to those measured in situ. Intramural metastasis was observed in 26% of the cases. Sixty four per cent (16 cases) of these were on the oral side, 72% (18 cases) on the gastric side, and 25% (nine cases) on both sides of the tumours. The most distant extent of intramural metastasis from the primary tumour was from 0.5 cm to 7.7 cm (mean = 3.4 cm) on the oral side, and 0.5 to 9.5 cm (mean 4 cm) on the gastric aspect of the tumour. Intramural metastasis was seen only in patients in whom the primary cancer had deep muscle infiltration. Multiple neoplastic lesions could be detected in 33% of the patients. Both intramural metastasis and multiple neoplastic lesions were associated with extensive lymph node infiltration. However, they had different histological features and extent of infiltration.
Intramural metastasis was frequently observed in oesophageal squamous cell carcinoma. This implies that excision with wide margins should be considered for local control of the disease.
（1）研究食管鳞状细胞癌壁内转移的发生率和范围，以便确定这些肿瘤的切除边界；（2）设计一种合适的测量这些病变的方法，该方法要考虑到切除标本后的收缩情况。
在两年时间里前瞻性收集了96例原发性食管鳞状细胞癌患者（87例男性，9例女性）的食管切除标本。在原位、切除后以及应用肌肉松弛剂后（以恢复其原位长度）测量肿瘤大小。然后将标本连续切片进行组织学检查。
应用肌肉松弛剂后测量的肿瘤大小大致与原位测量的大小相符。26%的病例观察到壁内转移。其中64%（16例）在肿瘤口侧，72%（18例）在胃侧，25%（9例）在肿瘤两侧。肿瘤壁内转移距原发肿瘤的最远距离在口侧为0.5厘米至7.7厘米（平均 = 3.4厘米），在肿瘤胃侧为0.5至9.5厘米（平均4厘米）。壁内转移仅见于原发性癌有深层肌肉浸润的患者。33%的患者可检测到多个肿瘤性病变。壁内转移和多个肿瘤性病变均与广泛的淋巴结浸润有关。然而，它们具有不同的组织学特征和浸润范围。
食管鳞状细胞癌中经常观察到壁内转移。这意味着为了局部控制该病应考虑进行宽切缘切除。
