下咽頭癌治療後の経過観察中に異時性多発食道癌および胃癌の発生を認めた1例

Metachronous Multiple Esophageal Cancers and a Gastric Cancer after Treatment for Hypopharyngeal Cancer, Report of a Case

要旨　患者は73歳，男性．1983年，下咽頭癌に対して放射線療法を施行されて完全緩解が得られた．1994年3月，定期検診目的で施行した上部消化管内視鏡検査にて，中部食道後壁に30mm大の表在型食道癌が発見され内視鏡的粘膜切除術（EMR）を施行．1997年3月，EMR瘢痕の近傍前壁に10mm大の，2000年3月，頸部食道後壁に14mm大の表在型食道癌が認められ，いずれもEMRを施行した．2000年3月，胃体上部大彎に11mm大の早期胃癌も認められ，同部に対してもEMRを施行した．本症例は，頭頸部癌患者や食道癌患者における異時性重複・多発癌の早期発見および治療に，上部消化管内視鏡検査による定期的な経過観察が重要であることを示す貴重な症例と思われ報告した．

　The patient was a 73-year-old man with moderate drinking and mild smoking habits. During a medical check-up, eleven years after radiation therapy for stage Ⅰ hypopharyngeal cancer (at the age of 67 years), an iodine-unstained slightly depressed lesion, 30 mm in diameter, was detected by endoscopy in the mid-esophagus (Fig.1). The biopsy result was squamous cell carcinoma, so endoscopic mucosal resection (EMR) was performed. Histopathological study revealed an 0-Ⅱc type of mucosal cancer without vessel infiltration. Three years after the first EMR (at the age of 70 years), a new iodine-unstained flat lesion, 10 mm in diameter, was detected on the side of the esophagus opposite the EMR scar (Fig.2). The biopsy result was squamous cell carcinoma and EMR was performed. Histopathological study revealed an 0-Ⅱb type of mucosal cancer without vessel infiltration. Three years after the second EMR (at the age of 73 years), another iodine-unstained slightly depressed lesion, 14 mm in diameter, was detected on the cervical esophagus (Fig.3). The biopsy result was squamous cell carcinoma and, again, EMR was performed. Histopathological study revealed an 0-Ⅱc type of epithelial cancer without vessel infiltration. At the same time, a slightly elevated whitish lesion, 11 mm in diameter, was detected on the greater curve of the upper gastric body (Fig.4). The biopsy revealed well-differentiated adenocarcinoma and the lesion was treated with EMR. Histopathological study revealed an 0-Ⅱa type of mucosal cancer without vessel infiltration. This case shows the importance of endoscopic follow-up for patients with head and neck cancers and/or esophageal cancers. Early detection of metachronous cancers enables the patients to recover with excellent prognosis and better quality of life with preservation of organs.