リンパ節転移を認めた表層拡大型食道粘膜癌の1例

Superficial Spreading Mucosal Cancer of the Esophagus with Lymph Node Metastasis, Report of a Case

要旨　リンパ節転移を認めた表層拡大型食道粘膜癌の1例を報告する．患者は55歳の男性．検診の内視鏡検査で食道癌を発見された．食道X線では胸部中部食道に両側性狭窄と約5cmの範囲の淡い不整陰影斑を認めた．食道内視鏡では同部に全周性の発赤を認め，ヨード染色で発赤部全体が不染帯となった．生検診断は扁平上皮癌であり，表層拡大進展したm3の0-Ⅱc型食道癌と診断し，リンパ節郭清を伴う根治術を施行した．切除標本ではわずかなびらん性変化がみられるのみであった．病理組織学的には大きさ6.0×5.9cm，大部分はm1で，中心部がm2，deeper cutしたごく一部のみがm3の低分化型扁平上皮癌であった．郭清した右上縦隔リンパ節に転移を1個認めた．

　A 55-year-old man who had been diagnosed as having esophageal cancer during a mass survey endoscopy was admitted to our hospital. X-ray examination of the esophagus showed mild stenosis and faint irregular barium flecks about 5 cm in width in the middle esophagus. Endoscopy of the esophagus revealed diffuse reddness in the middle esophagus which was not stained during iodine staining. A biopsy of the esophagus showed a squamous cell carcinoma. Under the diagnosis of superficial spreading mucosal cancer of the esophagus of type 0-Ⅱc partly reaching the muscularis mucosa (m3), a radical esophagectomy with lymphadenectomy was performed. Macroscopically, only a shallow erosive change was noted. Histologically, poorly differentiated squamous cell carcinoma mainly within the shallow lamina propria mucosa (m1), and partly within the deep lamina propria mucosa (m2), was shown. The deeper cut of m2 sections revealed a localized invaion of ms. Lymph node metastasis was demonstrated in the right upper mediastinum.