一部にverrucous carcinoma様発育形態を伴った0-Ⅱa＋Ⅱc型食道表在癌の1例

Superficial Esophageal Carcinoma (0-Ⅱa+Ⅱc), Part of which was Shown Histologically to be Verrucous Carcinoma, Report of a Case

要旨　患者は73歳，男性．心窩部不快感を主訴として当科に入院．内視鏡検査で小膨隆白色斑の集簇と発赤した浅い陥凹を認めた．これらの部分はヨード撒布で，ヨード不染帯を示した．食道二重造影像では下部～中部食道（Ei～Ⅰm）に顆粒状粘膜を認め，その口側には少し濃いバリウムの付着を認めた．0-Ⅱa＋Ⅱc型食道表在癌，深達度mmと診断した．切除標本では，97×45mmの大きさの病変を認め，胃側には白色小結節状の少し隆起したⅡa部分とその口側には浅い陥凹を示すⅡc部分があり，これらの部分はヨード不染帯を示した．病理組織診断は，高分化型扁平上皮癌でⅡaの部分はverrcous carcimomaの発育形態を示し，深達度はmm₃，Ⅱcの部分は深達度epとmm₁であった．

　A 73-year-old man was admitted to our hospital with the chief complaint of epigastric discomfort. Endoscopic examination showed slightly elevated, whitish plaques scattered on the mucosa in the middle of the esophagus and a reddish, slightly depressed area on the oral side of the elevated lesion. The mucosal lesions were revealed as a clearly demarcated unstained area after iodine staining. Double contrast radiograph of the esophagus demonstrated granular mucosa in the middle of the esophagus and faint barium coating on the oral side of the granular lesion. The diagnosis of this lesion was type 0-Ⅱa+Ⅱc superficial esophageal carcinoma with invasion limited to the lamina propria mucosae (mm). Macroscopic finding of the resected material showed a Ⅱa lesion consisting of a flat, nodular, elevated lesion and a Ⅱc lesion consisting of a reddish, slightly depressed area, measuring 9.7×4.5 cm. This lesion was clearly recognizable as an unstained area after iodine scattering. Histological examination revealed well differentiated squamous cell carcinoma with invasion to the deeper layer of the lamina propria mucosae (mm₃) in the Ⅱa lesion, and invasion limited to the epithelium (ep) and to the shallow layer of the lamina propria mucosae in the Ⅱc lesion. In the Ⅱa lesion, the growth appearance of a verrucous carcinoma was noticed.