粘膜下腫瘍様の食道表在癌の2例

Submucosal Tumor Type of Superficial Esophageal Cancer, Report of Two Cases

要旨　様々な組織型を示す粘膜下腫瘍様の食道表在癌は個々の症例に適した治療が必要でその診断は重要である．〔症例1〕はなだらかな小隆起性病変（0-Ⅰ）とその肛門側に陥凹性病変（0-Ⅱc）があり，0-Ⅰ病変は生検で未分化癌の診断を受け，内視鏡的粘膜切除（EMR）を施行し切除した．化学療法を施行したが0-Ⅱc病変は不変なため食道切除手術を施行し，再発なく長期生存中である．〔症例2〕は早期胃癌で胃全摘術後に，経過観察の内視鏡検査で食道病変を指摘された．病変は後壁中心に約1/3周を占める凹凸を示す隆起性病変である．組織は多形性を示す未分化な部分を有する低分化型扁平上皮癌であった．食道亜全摘術および化学療法を施行したが，3年半後再発，死亡した．

　Because submucosal type of superficial esophageal cancer consists of various histologic types, treatment strategy might change with individual patients. The first patient was a 59-year-old man with a small protruding tumor (0-Ⅰ) and superficial cancer (0-Ⅱc). Diagnosis on biopsy specimens of 0-Ⅰ tumor was oat-cell-type undifferentiated carcinoma. The patient underwent esophagectomy for the remaining unchanged 0-Ⅱc cancer after endoscopic mucosal resection (EMR) and chemotherapy for 0-Ⅰ tumor. These treatments resulted in long survival of this patient. The second patient was a 68-year-old man who underwent total gastrectomy for early gastric cancer and who was diagnosed as having an esophageal irregular protruding tumor. His lesion consisted of two protruberant tumors with iodine staining at the tops. The patient underwent esophagectomy and reconstruction with the ileo-colon. Histologically, the tumor was poorly differentiated squamous cell carcinoma with pleomorphism. Although chemotherapy was given, this patient died with recurrent tumor in the liver and lymph nodes.