Clinicopathologic Study on Intramural Lymphatic Flow of Esophageal Carcinoma

Ichiro Shima, Teruo Kakegawa, Hideaki Yamana, Hiromasa Fujita, Mitsuo So, Koji Irie*, Minoru Morimatsu*

First Departments of Surgery and Second Pathology*, Kurume University School of Medicine

To investigate the intramural lymphatic spread of esophageal carcinoma, intramural metastasis (IM) and lymphatic permeation (LP) to a distance of more than 5 mm or spreading more than 10 mm from the primary lesion were determined clinicopathologically in 422 patients with esophageal carcinoma. Forty-nine lesions of IM in 25 patients (6%) and 29 lesions of LP in 18 patients (4.3%) were observed. IM lesions were located mainly in the submucosal (sm) (51%) or the lamina proprial muscular (lpm) layer (21%). One reason for this, there is a rich and complicated network of lymphatics in the sm and the lpm layer. On the other hand, LP lesions were located in the lpm (60%) or the muscularis proprial (mp) layer (24%). Most of the MP and the LP lesions were within 4 cm from the primary lesion. Interestingly, one-third of the IM or the LP lesions situated in the upper third of the esophagus were in the mp layer which has a poor network of lymphatics, while most of the IM or the LP lesions situated in the middle and the lower thrid of the esophagus were located in the lpm and/or the sm layer. These results suggest that the lymphatic route in the upper third of the esophagus is predomionantly in the lateral direction rather than via longitudinal direction, whereas the lymphatic route of the middle and the lower third of the esophagus is predomoninantly through the longitudinal ducts spreading to the perimucosal lymphatics.

Key words
esophageal cancer, intramural metastasis of esophageal carcinoma, lymphatic permeation of esophageal carcinoma, lymph node metastasis of esophageal carcinoma, lymphatic route of the esophageal wall

Reprint requests
Ichiro Shima The First Department of Surgery, Kurume University School of Medicine
Asahi-machi, Kurume-shi, 830 JAPAN

Accepted
January 13, 1993

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