頸部食道腺癌の1例

Adenocarcinoma of the Cervical Esophagus, Report of a Case

要旨　患者は57歳，男性．嚥下困難を主訴に前医を受診し，頸部食道に腫瘍を認めたため当院へ紹介となった．精査の結果，頸部食道右壁，長径4cmの2型食道癌と診断した．生検結果は高分化型腺癌であった．手術は食道全摘（非開胸），後縦隔胃管再建を行った．切除標本では頸部食道に3.5cmの2型腫瘍を認め，T4（気管）N1 M0 IM0 Stage IVaであった．病理診断は中分化型腺癌であった．腫瘍周囲の扁平上皮の粘膜下に胃粘膜上皮が存在することから，腫瘍は異所性胃粘膜由来と考えられた．本邦における食道腺癌は食道癌全体の2％程度である．治療法や予後は扁平上皮癌と大差はないと言われているが，Barrett上皮以外の腺癌の報告は少ないため，今後症例の集積が必要である．

　A 57-year-old male was introduced to our hospital by a clinician who had found a tumor in the patient's cervical esophagus. X-ray examination of the upper gastrointestinal tract and upper gastrointestinal endoscopy revealed an ulcerative and localized-type tumor, measuring 4cm in diameter, on the right side of the wall of the cervical esohophagus. Histological studies of bite biopsy specimens revealed a well-differentiated adenocarcinoma. Total esophagectomy was carried out. Pathological studies of the resected specimens revealed a moderately differentiated adenocarcinoma, pT4 (trachea) N1 M0 IM0 StageIVa. The submucosal lesion neighboring the cancer revealed gastric foveolar epithelium. With this data in mind, the lesion was eventually judged to have originated from ectopic gastric epithelium.