0-Ⅱc＋Ⅱb型Barrett食道癌の1切除例

Type 0-Ⅱc＋Ⅱb Superficial Adenocarcinoma Arising from Barrett's Esophagus, Report of a Case

要旨　患者は73歳，男性．自覚症状は特になく，近医で行った上部消化管内視鏡検査で下部食道の病変を指摘され，当科紹介入院した．内視鏡検査では食道裂孔ヘルニアと最長8cmにわたるBarrett食道を認めた．Barrett食道下端右側壁に1.5cm大の浅い陥凹性病変と，これに連続する約半周性の発赤粘膜を認めた．生検で高分化型腺癌と診断され，Ⅱc＋Ⅱb型Barrett食道腺癌と診断した．クリスタルバイオレット染色を併用した拡大内視鏡観察では，Hb病変は腺溝模様が消失した無構造な領域として認識された．非開胸食道抜去術を施行し，4.0×2.5cmの高分化型腺癌，深達度m，ly₀，v₀であった．

　A 73-year-old male was referred to our department for more detailed evaluation of an esophageal depressed lesion. Endoscopic examination revealed a sliding hiatal hernia and a columnar epitheliumlined esopha-gus for 8 cm at its greatest length. A slightly depressed lesion was observed adjacent to the esophago-gastric mucosal junction and smooth-surfaced erythematous mucosa was observed surrounded by the depressed component. The biopsy specimens from the lesion showed well-differentiated adenocarcinoma and were diagnosed as type 0-Ⅱc ＋ Ⅱb adenocarcinoma arising from Barrett's esophagus. Thoracic esophagectomy without thoracotomy was performed. Histological study of the resected specimen demonstrated that the columnar epithelium had intestinal metaplasia and a welldifferentiated adenocarcinoma limited to the mucosa.