食道表在型小細胞型未分化癌の1切除例

Superficial-type Small Cell-type Undifferentiated Carcinoma of the Esophagus, Report of a Case

要旨　患者は80歳，女性．主訴は前胸部不快感．上部消化管内視鏡検査で食道中部に長径2cm，楕円形の扁平隆起性病変を認めた．腫瘍の立ち上がりは明瞭で，隆起の辺縁近くは正常上皮で覆われるが，中央は発赤調，腫瘍の露出を認め，粘膜下腫瘍様発育が考えられた．ヨード染色内視鏡像では隆起の辺縁は淡染色性で，中央では不染であった．生検では未分化癌を強く疑うが，低分化型扁平上皮癌と診断された．十分な同意の下，非開胸食道抜去術を施行した．病理学的検査では小細胞型未分化癌，pT1b（sm3），ly（＋），v（＋），pN0，pStageIであった．術後経過は良好であったが，術後7か月目の腹部CT検査にて，多発性肝転移がみられ，術後8か月目に肝不全により死亡された．食道小細胞型未分化癌は表在癌でもその予後は不良で，手術療法だけでは良い結果が望めず，さらなる集学的治療が望まれると考えられた．

　An 80-year-old woman presented chest discomfort. Endoscopic examination revealed an elliptical flat-elevated lesion in the middle third of the esophagus. It was 2 cm in its long diameter. Although the boundary of the tumor was clear and the circumference was covered by normal epithelium, the central portion was reddish like a submucosal tumor. The circumference was slightly stained, but the central portion was not stained with iodine stain. Biopsy led to a diagnosis of poorly differentiated squamous carcinoma with small cell-type undifferentiated carcinoma.

　We performed esophagectomy using blunt dissection under fully informed consent.

　Pathologically it was a small cell-type undifferentiated carcinoma pT1b (sm3), ly (＋), v (＋), pN0, pStageI.

　The patient was improving well after the operation, but 7 months later, a computed tomographic scan of her abdomen revealed multiple liver metastasis. 8 months after the operation, she died of liver failure.

　We reported that the prognosis for surgery of small cell-type undifferentiated carcinoma of the esophagus is poor even in cases of superficial carcinoma.