粘膜癌から進行癌への発育進展を観察しえた食道癌の1例

Natural Course of a Mucosal Carcinoma of the Esophagus : Tumor Progression to Advanced Cancer, Report of a Case

要旨　患者は67歳，女性．食道違和感を主訴に近医を受診した．内視鏡検査で胸部下部食道（Ei）に食道表在癌を発見され精査加療目的で当院に紹介入院となった．術前精査ではEi，後壁，長径5cm，1/2周性，0-Ⅱc＋Ⅱb型食道表在癌で深達度m3と診断した．手術適応と判断したが，治療拒否のために退院となり，経過観察となった．1か月半で粘膜下層，12か月で固有筋層への浸潤が疑われ，20か月では全周性3型に発育した．22か月で多発肝転移を認め，癌性食道狭窄による経口摂取困難を呈し再入院となった．食道ステント挿入術を施行し退院となったが，その1か月後に死亡した．

　An esophageal lesion in the lower intra-thoracic esophagus was detected in a 67 year-old woman by endoscopic examination. She complained of retrosternal discomfort, and was admitted to the Tokai University hospital for further examination and treatment. The preoperative examinations made a diagnosis of type Ⅱc ＋ Ⅱb superficial esophageal carcinoma on the posterior wall of the lower thoracic portion. The lesion was thought to be an early carcinoma limited to the muscularis mucosa (depth m3), measuring 5 cm in length, occupying one half of the circumference. She was discharged and followed up in our out-patient clinic, because she rejected undergoing therapy. One month and a half after the initial examination, the tumor was thought to have invaded the submucosa. 12 months after, it had extended into the muscularis propria. The tumor became a type 3 advanced cancer 20 months after the initial study. Finally, multiple liver metastasis and esophageal stenosis were observed. The patient was readmitted, and an esophageal stent system was inserted. She died due to the advanced tumor progression 1 month after the treatment.