食道に生じた隆起型印環細胞癌の1例

Elevated-type Signet-ring Cell Carcinoma of the Lower Esophagus, Report of a Case

要旨　患者は68歳の男性．食道静脈瘤経過観察中，内視鏡検査にて下部食道に境界明瞭な隆起性病変を認めた．生検で印環細胞癌であり，噴門部に生じた早期癌の診断で下部食道を含む噴門側胃切除を施行した．切除標本で腫瘍は大きさ23×11mm，Ⅱa型の隆起性病変で，粘膜下層に浸潤する印環細胞癌であった（sm₁，ly₁，v₀）．リンパ節転移はなく，現在まで再発を認めない．組織学的検索の結果は，下部食道に生じた早期の印環細胞癌であり，隆起型を呈する興味ある症例であった．

　Signet-ring cell carcinomas of the esophagus is rare. Herein, we report a case of elevated-type signet-ring cell carcinoma of the lower esophagus.

　A 68-year-old man underwent esophago-gastric endoscopy as a follow-up of esophageal varices. This examination revealed an elevated lesion with clear boundary and granular surface in the lower esophagus. The biopsy specimen revealed signet-ring cell carcinoma. Proximal gastrectomy with combined resection of the abdominal esophagus was carried out. Macroscopically, the tumor was elevated, measuring 23 mm × 11 mm in size, in the lower esophagus. Microscopically the tumor was composed of a proliferation of signet-ring cells invading the upper part of the submucosal layer (sm₁, ly₁, v₀), but there was no lymph node metastasis. In addition, this carcinoma was considered to be associated with short segment type Barrett's esophagus.