粘膜下腫瘍様の発育を呈しlymphoid stromaを特徴とした0-Ⅲ型様食道表在癌の1例

Submucosal Tumor-like Superficial Esophageal Carcinoma with Lymphoid Stroma Seeming Type 0-Ⅲ, Report of a Case

要旨　患者は54歳，男性．検診の上部消化管造影検査で食道に異常を指摘され近医を受診した．内視鏡検査で胸部上部食道右壁に病変を認めたが，生検の結果では明らかな悪性所見が得られず精査加療目的に当院に紹介入院となった．内視鏡検査では，表面全体が正常食道上皮で被覆され粘膜下腫瘍様の形態を呈し辺縁に周堤様隆起を伴う陥凹性病変を認めたが，ヨード染色で染色性を示した．生検組織で一部に上皮のびらんと炎症性変化を呈し，同部で扁平上皮癌を認めたため0-Ⅲ型食道表在癌と診断し，右開胸開腹胸部食道切除術RⅢを施行した．病理組織学的に0-Ⅲ型様病変は，上皮下に主座のある低分化型扁平上皮癌で濾胞形成を伴ったlymphoid stromaを特徴とした髄様型で，深達度sm2，infα，ly₀，v₀，n(－)と診断された．

　An esophageal lesion was detected in a 54-year-old man by esophagography during a medical check-up. No malignant features were noted in the biopsy specimen which was taken from the esophageal lesion on the right wall of the upper thoracic portion. The patient was admitted to the Tokai University hospital for further examination and treatment. The endoscopic findings revealed that the lesion was depressed with a round wall, covered with normal eshophageal epithelium, mimicking a submucosal tumor, and stained with iodine. The esophageal biopsy specimen showed that the mucosal surface was slightly erosive and inflammatory, associated with infiltration of atypical squamous cells. Under the diagnosis of type 0-Ⅲ, superficial esophageal carcinoma because of both endoscopic and microscopic features, a total esophagectomy using a right thoraco-laparotomy with lymph nodal dissection, R-Ⅲ, was performed. The histological findings of the resected specimen led to the diagnosis of poorly diffe-rentiated squamous cell carcinoma with invasion to the submucosa (sm2) and the overlying normal squamous cells: infα, ly₀, v₀, n(-). This lesion was characteristic of so-called medullary ploliferation accompanied by lymphoid stroma.