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Stomach and Intestine(Tokyo) Volume 30, Issue 8 （July 1995）

胃と腸 30巻8号（1995年7月発行）

Japanese English

今月の主題表層拡大型食道表在癌

主題症例

リンパ節転移を有した表層拡大型食道粘膜癌の1例 Superficial Spreading-type Mucosal Carcinoma of the Esophagus with a Lymph Node Metastasis, Report of a Case 永井鑑 ¹ , 河野辰幸 ¹ , 堀光 ¹ , 中村正徳 ¹ , 矢野謙一 ¹ , 井上晴洋 ¹ , 吉野邦英 ¹ , 遠藤光夫 ¹ , 谷澤徹 ² , 江石義信 ² Kagami Nagai ¹ , Tatsuyuki Kawano ¹ , Kunihide Yoshino ¹ , Mitsuo Endo ¹ , Tooru Tanizawa ² ¹東京医科歯科大学第1外科 ²東京医科歯科大学病理部 ¹The First Department of Surgery, Tokyo Medical and Dental University ²Department of Pathology, Tokyo Medical and Dental University キーワード：食道粘膜癌 , 表層拡大型 , リンパ節転移 , 内視鏡的超音波検査 , ソフトバルーン内走査法 Keyword: 食道粘膜癌 , 表層拡大型 , リンパ節転移 , 内視鏡的超音波検査 , ソフトバルーン内走査法 pp.1067-1070

発行日 1995年7月25日 Published Date 1995/7/25

DOI https://doi.org/10.11477/mf.1403105485

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要旨　リンパ節転移を有する表層拡大型食道粘膜癌を経験した．患者は74歳，男性．心窩部痛のため内視鏡検査を受けた．ImEiに広い発赤陥凹面と内部に顆粒状変化を有する0-Ⅱc＋Ⅱa型食道癌で，大きさ8.0×4.5cm，中分化型扁平上皮癌，深達度はm3（大部分はm1からm2で，顆粒状の一部でm3），ly₁，v₀，No.108リンパ節に1個転移を認めた．表層拡大型食道癌の深達度診断には，従来からのX線・内視鏡検査に加え，ソフトバルーン内走査法による内視鏡超音波検査が有用と思われる．当科ではこれまで14例の表層拡大型粘膜癌を切除し，再発死亡例はない．本症例は表層拡大型表在癌の診断・治療・予後を考えるうえで興味ある1例と思われるので報告する．

　A 74-year-old male visited our hospital for further examination and therapy of the esophagus in May, 1994. Esophagogram revealed wide mucosal irregularity with some granularity on the middle to lower intrathoracic esophagus. Endoscopically, a slightly depressed reddish mucosal area of about 10 cm in length was recognized and was unstained with iodine solution. There were some granularly elevated portions and white-coated parts within this area. The lesion was diagnosed as a superficial spreading carcinoma of type 0-Ⅱc＋Ⅱa. Endoscopic ultrasonography (EUS) through a soft balloon revealed obvious irregularity in the 1st and 2nd layer, but no remarkable changes in the 3rd-a layer. Synthetically, the depth of cancer invasion was estimated as m3 in the preoperative period. A subtotal esophagectomy with lymph node dissection and posterior mediastinal esophago-gastrostomy were performed.

　Histopathological examination showed a moderately differentiated squamous cell carcinoma, 8.0 × 4.5 cm in size, partly reaching the lamina muscularis mucosa (m3). Slight lymphatic invasion (ly₁, v₀) and one regional lymph node metastasis (No.108) were also found.

　Not only conventional esophagogram and chromoendoscopy, but also EUS through a soft balloon are thought to be useful means for the estimation of the depth of cancer invasion, especially in such superficial spreading carcinomas as this case.

　We have operated on 14 cases of superficial spreading mucosal carcinomas of the esophagus, so far, and there have been no recurrences after the operations. This case is thought to be interesting, considering the diagnosis, surgical therapy, and prognosis of superficial spreading carcinomas of the esophagus.