食道結核による粘膜下腫瘍様隆起上の早期食道癌の1例

Early Esophageal Cancer Coexisting with Submucosal Tumor Caused by Esophageal Tuberculosis, Report of a Case

　患者は71歳，男性．心窩部不快感を主訴に来院．X線検査でUt下部に30×15mmの粘膜下腫瘍様の隆起性病変と，その外側に石灰化を認めた．内視鏡検査で上切歯列より23cmに粘膜下腫瘍様の隆起を認め，この隆起上に15mmほどのわずかな発赤陥凹を認めた．陥凹部はトルイジンブルーに一部淡染し，ヨードに不染を呈した．EUSで粘膜下層以深の深層に石灰化を認めた．食道結核による粘膜下腫瘍様隆起上の早期食道癌と診断し，内視鏡的粘膜切除を施行．陥凹性病変は15×13mmでヨード不染部に一致した．0-IIc，扁平上皮癌，m2と診断した．

　A 71-year-old man was referred to our hospital with epigastric discomfort. Esophagogram revealed a submucosal tumor measuring 30×15 mm at the upper thoracic esophagus. Endoscopically, a small reddish depression was seen on the surface of the submucosal tumor. The depression weakly stained with toluidine blue, but the lesion remained unstained with iodine. Endoscopic mucosal resection was performed. Histological examination of the depression revealed intramucosal squamous cell carcinoma. The causative relation between the esophageal tuberculosis and the squamous cell carcinoma is unclear but in this case, constant mechanical stimulation may have caused malignant deterioration of the epithelium overlying the submucosal tumor.