0-Ip＋Ⅱc型を呈した食道粘膜癌の1例

Type 0-Ip+Ⅱc Esophageal Cancer Confined within the Muscularis Mucosae, Report of a Case

要旨　患者は57歳，男性．人間ドックの上部消化管X線検査で食道の隆起性病変を指摘され，内視鏡検査で食道癌と診断され，当科紹介入院となった．食道造影検査で，胸部中部食道に隆起性病変を認め，口側・肛側両側に溝状のごく淡い不整陰影像の進展を認めた．食道内視鏡検査では，上切歯列から28cmの右壁に結節状隆起を認め，25～31cmまで隆起を中心に3/4周性にⅡc面が拡がっていた．また主病変の口側前壁にはⅡc型副病変を認めた．0-Ip＋Ⅱc型食道癌，深達度smlと診断し，開胸食道切除を行った．術後病理組織学的所見では，O-lp＋Ⅱc型食道癌で，深達度は2か所で粘膜筋板（m3）に達するにとどまっていた．O-Ip＋Ⅱc型食道癌の肉眼形式を呈したにもかかわらず，深達度m₃にとどまった食道表在癌の1例を経験したので報告した．

　A 57-year-old male was admitted to the hospital for further examination and treatment of esophageal carcinoma.

　An elevated lesion at the middle portion of the esophagus was observed by upper gastrointestinal tract examination in a regular medical checkup performed in Feburuary, 1995. In April, the patient was diagnosed as having an esophageal carcinoma by endoscopic examination, and was referred to the hospital.

　Examination of the esophagus revealed an irregular‐shaped elevation with a stalk at the middle of the esophagus, and a slightly depressed, irregular‐shaped lesion extended to both the oral and the anal side from the elevated lesion. Endoscopical examination of the esophagus revealed an elevated lesion at the right wall at 28cm from the incisors, and a slightly depressed lesion (Ⅱc) occupied three quarters of the circumference of the esophagus, at the portion 25～31 cm from the incisors. At the right wall on the oral side of the elevated lesion, another slight depressed lesion was found. Collectively, a type 0-Ip+Ⅱc esophageal cancer was diagnosed and cancer invasion was estimated as sm1. Subtotal esophagectomy with lymph node dissection was performed in June. Microscopic examination revealed a poorly differentiated squamous cell carcinoma with invasion of m3 at two points. Thus we report a case of superficial esophageal cancer in which invasion was limited within m3, although it presented findings of a type 0-Ip+Ⅱc of esophageal cancer macroscopically.