0-Ⅱa様の形態を呈し著明なkoilocytosisを伴った食道dysplasiaに隣接して微小0-Ⅱcを認めた1例

Esophageal Dysplasia with Marked Koilocytosis Accompanying Minute Squamous Cell Carcinoma in Situ, Report of a Case

要旨　患者は51歳，男性．人間ドックで食道病変を指摘され来院．X線検査でIm下部に分葉状の平坦隆起を認めた．内視鏡検査で上切歯列から36cmに白色調の扁平隆起とその口側に接し微小発赤を認め，トルイジンブルー染色で隆起表面は亀甲様に染まり，ヨード染色で隆起は淡染，口側の発赤は不染を呈した．隆起部の生検診断はdysplasiaであった．内視鏡的粘膜切除術を施行．隆起は10×7mmで核周囲に空泡を伴う細胞が出現しkoilocytosisの所見を呈していた．同部はdysplasiaと診断しヒトパピローマウイルスとの関連を考えた．隆起の口側に隣接し2mmの陥凹があり内視鏡での微小発赤と一致した．同部は0-Ⅱc，扁平上皮癌，m₁と診断した．

　A 51-year-old man was referred to our hospital for further examination of esophageal tumor. Esophagogram revealed a lobulated flat elevation measuring 11 × 7 mm at the lower thoracic esophagus. Endoscopically, the elevation was whitish and fine grooves were seen on the surface, which stained like tortoise shell with toluidine blue. Adjacent to the oral side of the elevation, a tiny reddish depression was seen. The elevation weakly stained with iodine, but the depression remained unstained. Endoscopic mucosal resection was performed. Histological examination of the elevation revealed moderate dysplasia. Marked koilocytosis was observed at the elevation, which was suggestive of human papillomavirus-related atypia. Meanwhile, the depression was found to consist of squamous cell carcinoma in situ. In situ hybridization for human papillomavirus DNA was negative.