長径10mm未満のBarrett上皮に発生した早期食道腺癌の1例

Early Esophageal Adenocarcinoma Arising in Short Segment Barrett's Esophagus, Report of a Case

要旨　患者は65歳，男性．心窩部痛を訴えて近医を受診，消化管透視で下部食道に腫瘍を認めた．精密食道透視で下部食道右側壁に不整な陥凹を伴う隆起性病変を認め，弧状の側面変形を認めた．内視鏡検査では腫瘍は発赤調の中心陥凹を伴う隆起性病変で，辺縁隆起部は白色調の重層扁平上皮で覆われ，粘膜下腫瘍様の形態を示していた．食道裂孔ヘルニアを伴い，狭い範囲のBarrett上皮を認めた．以上から，0-Ⅰsep型のBarrett食道癌，深達度はsm3と診断し，下部食道切除術を施行した．病理組織学的には0-Ⅰsep，sm3，tub1＋2，ly₀，v₀，n₀，17×16mmの早期Barrett食道癌で，Barrett上皮は最長でも7mmの狭い範囲にしか認めなかった．自験例はBarrett上皮が10mm以下でも腺癌が発生しうることを示した貴重な症例と考えられた．早期Barrett食道癌のわが国の報告例31例の文献的考察を加えて報告する．

　A 65-year-old man was admitted to our hospital for further evaluation of epigastralgia and an esophageal tumor. An upper gastrointestinal series showed a subepithelial tumor-like protruded lesion with reddish and shallow depression. Biopsy specimen revealed moderately differentiated adenocarcinoma. Moreover, Hiatal hernia and short-segment Barrett's esophagus were found. Lower esophageal resection was performed. The resected specimen revealed esophageal adenocancinoma (0-Ⅰ sep, sm3, tub1 ＋ 2, infβ, ly₀, v₀, n₀, 17 × 16 mm). The authors reviewed 31 cases of early esophageal adenocarcinoma arising in long or short segment Barrett's esophagus in Japanese literature.