ESD後の経過観察でリンパ節転移が認められた症例

Adenocarcinoma of the Zone of the Esophagogastric Junction with Lymph Node Metastasis Detected During Follow-up After Endoscopic Submucosal Dissection, Report a Case

要旨●患者は80歳代，男性．健診で施行した上部消化管内視鏡検査（EGD）にて食道胃接合部に異常を指摘され，当科へ紹介となった．通常観察およびNBI拡大観察で不整な表面構造と異型血管を伴う0-IIc型病変を認め，超音波内視鏡（EUS）にて粘膜下層への浸潤が疑われた．十分な説明を行ったうえでESDを施行し，一括切除した．切除標本は56×33mmの0-IIc型病変で，Barrett食道腺癌（tub1>tub2），pT1b-SM1（350μm），Ly0，V0，断端陰性と診断された．腫瘍径30mmを超える粘膜下層浸潤癌であり追加外科切除を推奨したが，患者の強い希望により経過観察となった．ESDから2年6か月後に多発リンパ節転移再発が確認され，化学療法を施行するも病勢は進行し，3年9か月後に永眠された．

　An 80-year-old male patient was referred to our hospital after an abnormality at the esophagogastric junction was detected during screening upper gastrointestinal endoscopy. Magnifying endoscopy with narrow-band imaging revealed a 0-IIc lesion with irregular surface structure and irregular vessels, and endoscopic ultrasonography suggested submucosal invasion. After obtaining the patient's informed consent, endoscopic submucosal dissection（ESD）was performed, achieving en bloc resection. The resected specimen measured 56×33mm, and histopathological examination revealed Barrett's adenocarcinoma（tub1>tub2）, pT1b-SM1（350μm）, Ly0, V0, with negative resection margins. As the lesion was a submucosally invasive carcinoma measuring >30mm in diameter, additional surgical resection was recommended ; however, careful surveillance was chosen as per the patient's strong preference. Thirty months after ESD, multiple lymph node metastases were detected. Despite systemic chemotherapy, the disease progressed, and the patient died 45 months after ESD.