Changes in the microvascular structure of mucosal squamous cell carcinoma of the esophagus and their significance in tumor progression.
BACKGROUND
To identify the clinical T stage by endoscopy is a major diagnostic goal for superficial esophageal squamous cell carcinoma (ESCC). The completion of a microvascular morphological study of mucosal lesions is necessary to optimize therapy.


METHODS
Images of 197 intra-papillary capillary loops (IPCLs) captured by magnified endoscopy from 15 esophagectomy specimens were studied for their morphological features and IPCL dimensions.


RESULTS
The microvascular morphology was classified into four basic major patterns: 1. spiral loop, 2. wide loop (WL), 3. globular (G) and 4. reticular pattern. The microvascular features and dimensions differed according to the depth of tumor invasion. Especially the mean bundle outline (IPCL diameter) showed significant changes as 20.02, 22.32, and 27.08 μm, respectively, for M1, M2 and M3, respectively (M1:M2 P < 0.05, M2:M3 P < 0.01).


CONCLUSIONS
During tumor stage progression, a high-volume blood demand and cancer cell overgrowth to occupy the laminar propria mucosa (LPM) cause obvious elongation, thickening, branching, irregularity and deformity of the IPCL, which were characteristics of M3 lesions. The results of the present study support and can be applied with the current Japanese classification for improving the diagnostic accuracy, especially to differentiate between M2 and M3 lesions based on the endoscopic findings.
Department of Esophageal and General Surgery, Tokyo Medical and Dental University.
Jirawat
J
Swangsri
Yasuaki
Y
Nakajima
Kenro
K
Kawada
Yutaka
Y
Tokairin
Tomoyoshi
T
Suzuki
Yutaka
Y
Miyawaki
Akihiro
A
Hoshino
Takuya
T
Okada
Shunsuke
S
Ota
Tairo
T
Ryotokuji
Naoto
N
Fujiwara
Tetsuro
T
Nishikage
Kagami
K
Nagai
Hiroshi
H
Kawachi
Tatsuyuki
T
Kawano
D002196:Capillaries / Q000473:pathology*; D002294:Carcinoma, Squamous Cell / Q000098:blood supply* / Q000473:pathology; D018450:Disease Progression; D055088:Early Detection of Cancer; D004938:Esophageal Neoplasms / Q000098:blood supply* / Q000473:pathology; D016629:Esophagectomy; D004945:Esophagoscopy / Q000379:methods; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D009040:Motion Pictures; D009092:Mucous Membrane / Q000098:blood supply / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010781:Photography