粘膜内癌から進行癌への発育進展が内視鏡的に観察された食道癌の1例

Esophageal Carcinoma Followed Up Endoscopically, Report of a Case

要旨　患者は74歳，男性．食思不振，上腹部不快感を主訴に1995年9月に来院した．内視鏡検査を受け，胸部中部食道から胸部下部食道に長径7cmの全周性の0-IIc型病変(扁平上皮癌)が指摘された．X線，内視鏡検査にて深達度m3の病変と診断され，強く治療を勧めたが，患者本人の治療拒否にて無治療で経過観察された．1996年12月の内視鏡所見では結節状の隆起を伴い，0-I+IIc型病変(推定深達度sm3)に変化していた．1997年3月の内視鏡検査では半周性の狭窄を認め，2+IIc型で深達度mpと診断された．1998年4月の内視鏡検査では病変は全周性の狭窄に進行した．この間，病変の長径にはほとんど変化を認めなかった．1999年3月に狭窄に対して金属ステントが挿入された．発見以来4年4か月経過した現在，外来通院中である．

　A 74-year-old male visited our hospital with complaints of appetite loss and upper gastrointestinal discomfort in September, 1995. Endoscopic examination revealed a slightly depressed lesion (Type 0-IIc) about 7cm in length in the middle and lower of the esophagus. Pathogical studies on a bite biopsy indicated squamous cell carcinoma. The depth of invasion was diagnosed as being as far as the muscularis mucosae by endoscopic and x-ray examinations. As the patient did not want to undergo any therapy, he was followed up endoscopically. In December, 1996, the lesion was recognized as a slightly depressed area with protruding nodules (Type 0-I + IIc) and was suspected to have invaded into the submucosa. In March, 1997, the lesion showed semi-stenosis of the esophageal lumen and was suspected to have invaded the muscularis propria. In April, 1998, the lesion had progressed to complete stenosis of the esophageal lumen and a metallic stent was inserted. The patient is still alive four years and four months after initial endoscopy.