1年6か月間追跡しえた食道小細胞癌の1例

Esophageal Small Cell Carcinoma Followed Up with Endoscopy for One Year and Six Months, Report of a Case

要旨　患者は58歳，女性．食道内視鏡検査で中部食道後壁に褪色したヨード不染の約0．5cmの小陥凹を見いだした．生検で小型の異型細胞が得られたが再検査を拒否した．1年6か月後に嚥下時の不快感のために再検査を受け，食道小細胞癌と診断された．同病変はX線的には立ち上がりの明瞭な隆起病変であり，頂部の左側にバリウム斑が存在した．内視鏡的には光沢を有する軽度発赤した結節状隆起部とヨード不染，トルイジンブルー濃染の陥凹部から成り立っていた．切除標本で大きさ1.5×1.3cmの腫瘍は上皮下に発達した0-Isep型をなし，深達度はsm3に達していた．腫瘍の大部分は小細胞癌組織で構成されているが，わずかに腺癌成分も含んでいた．

　A 58-year-female was diagnosed by endoscopy as having a pale depressed lesion on the posterior wall of the middle esophagus. The lesion was about 0.5 cm in diameter and was unstained by iodine spray method. Histological examination of the biopsy specimens revealed a small atypical cell nest including scanty glandular differentiation. The patient was recommended to undergo immediate reexamination but refused it. After one year and six months, she was reexamined for swallowing disorder and diagnosed as having small cell carcinoma of the esophagus. X-ray examination showed the protruded lesion with a clear margin and a barium plaque on the surface. Endoscopically the lesion consisted of the slightly reddish protruded part with a luster and the depressed part stained by toluidine blue but unstained by iodine. The size was 1.5×1.3 cm in the resected specimen. Microscopically, growing under the epithelium, the tumor had invaded to the deep submucosal layer and was composed of an abundance of small-cell carcinoma and some adenocarcinoma.