経内視鏡的バルーン拡張術後に発見されたBarrett食道腺癌の1例

Barrett's Adenocarcinoma Detected After Endoscopic Balloon Dilation, Report of a Case

要旨　患者は64歳，女性．50歳時に胃癌で胃全摘術兼食道・十二指腸吻合術を施行された．1994年8月18日，前胸部のつかえ感を自覚し当科を受診した．門歯列から23cmの食道Iu部に著明な輪状狭窄を認め，入院後リジフレックスバルーンダイレーターで拡張術を施行した．拡張後の精査にて門歯列から23～28cmの食道Im部に全周性の不整発赤調の凹凸粘膜を認め，生検で中分化型腺癌と診断した．その肛門側食道は門歯列から35cmの吻合部まで均一な細顆粒状粘膜で覆われ，生検でBarrett上皮と診断した．同年9月27日，食道切除術を施行した．切除標本でも広範なBarrett上皮に発生した0-Ⅱa型腺癌（sm₃，ly₀，v₁）と確認された．

　A 64-year-old female, who had a history of total gastrectomy with esophago-duodenostomy for early gastric cancer at the age of 50 years, was admitted to our hospital with a complaint of dysphagia. Her upper esophagus exhibited a circular narrowing, where there was no evidence of malignancy on biopsy specimens. Consequent to endoscopic balloon dilation, an adenocarcinoma presenting irregularly shaped elevated mucosa was recognized in the middle esophagus. The patient therefore underwent subtotal esophagectomy. On histologic examination, resected esophagus 10 cm in length was extensively covered by columnar epithelium with severe intestinal metaplasia, corresponding to the specialized columnar epithelium of Barrett's esophagus. In addition, moderate to poorly differentiated adenocarcinoma limited to the submucosa without lymph node involvement was identified in the area of the Barrett's esophagus.