副病変を伴い多彩な肉眼所見を示した表層拡大型食道表在癌の1例

Superficially-Spreading Type Esophageal Cancer Accompanied by Accessory Lesions, Report of a Case

要旨　患者は57歳，男性．肺炎にて入院となった。食道精密X線および内視鏡では中部食道に全周性に大小様々な顆粒や結節から成る表層拡大型病変を認め，目立った結節状隆起が3か所（口側より順に〔結節A，B，C〕）に認められた．ヨード染色では全周，長軸方向約5cmにわたりヨード不染で，本病変の口側に約5mmのヨード不染帯も認めた．トルイジンブルー染色は結節状隆起の表面性状の描出に有効であった．広義の表層拡大型食道癌，〔結節B，C〕でsm浸潤と診断し，3領域リンパ節郭清を伴う食道亜全摘出術を施行した．切除標本では中部食道に64×53mmの表層拡大型病変とその口側にごくわずかに赤色調を示す微小病変を認めた．病理組織学的には，①pType 0-Ⅰp＋Ⅱa＋Ⅱc，pT1b（sm₃），moderately（＞well）differentiated SCC，inf_α，ly₁・v₀，M0，pIM0，ie(＋)，pN2（＃1,108＋），Mt，circ，64×53mm，pStage Ⅱ，②pType 0-Ⅱc，Tis（m₁），SCC，Mt，5×4mmの多発食道癌であった．

　A 57-year-old man was admitted to our hospital with a cough. Double contrast radiograph of the esophagus and conventional endoscopy showed superficially-spreading type esophageal cancer with three nodular protruded lesions, accompanied by lateral deformity on the left and anterior wall. Chronoscopic findings using iodine staining showed an unstained area involving the entire circumference, measuring 5 cm in length. Subtotal esophagectomy was performed. The resected specimen revealed multiple esophageal carcinoma (1; pType 0-Ⅰp+Ⅱa+Ⅱc, pT1b (sm₃), moderately (＞well) differentiated SCC, inf_α, ly₁, v₀, M0, pⅠM0, ie (+), pN2 (#1,108+), Mt, circ, 64×53 mm, pStage Ⅱ, 2; pType 0-Ⅱc, Tis (m₁), SCC, Mt, 5×4 mm).