内視鏡的に8年4か月間経過観察しえた食道表在癌の1例

Superfical Esophageal Carcinoma (Type 0-Ⅱc) Followed Up Endoscopically for Eight Years and Four Months, Report of a Case

要旨　患者は88歳，男性．1986年7月（79歳時）健診で胃角部開大を指摘され来院した．内視鏡検査で食道中部に不整なびらん様陥凹を認め，0-Ⅱcを疑い生検し，食道粘膜癌と診断した．積極的治療を望まないために化学療法のみ施行し，定期的に内視鏡検査を施行し，経過観察となった．少なくとも，2年2か月まではep癌，4年4か月まではm癌，そして5年3か月まではsm癌と，非常に緩徐な進展であった．その後，6年4か月になって，病変の一部でmpへの浸潤が疑われた後，急速に進行し，8年4か月後，通過障害自覚時には潰瘍浸潤型，3/4周を占める進行癌となった．本症例は食道粘膜癌から進行癌へのほぼ自然な経過を経時的に捉えた点で興味ある症例と思われる．なお，経過中，胃の腺腫の癌化も観察された．

　This paper describes a case of superficial esophageal carcinoma which was followed up regularly for eight years and four months on endoscopy, from the first mucosal lesion to the last advanced one.

　The patient is a 88-year-old man now. He visited to our hospital on July 7, 1986 (at 79 years of age). On endoscopy, a slightly depressed lesion with fine granular surface was detected in the middle of the esophagus. The lesion was suspected to be early esophageal carcinoma (Type 0-Ⅱc) and the pathological findings indicated squamous cell carcinoma. As the patient did not want to undergo any surgery or aggressive therapy, he was followed up endoscopically about once a year. At least, for the first two years and two months, no morphological marked changes were seen and the depth of the lesion was considered to have remained as intraepithelial carcinoma (ep). After that, the primary lesion enlarged gradually and slightly in size, but the growth and progression of the carcinoma was very slow until four years and four months after its first detection.

　On October 25, 1991, after five years and three months, the lesion showed marked enlargement in size, and invasion to the submucosa was suspected.

　On November 13, 1992, its growth had progressed in size and was suspected to have partially invaded to the muscularis propria. On November 11, 1994, after eight years and four months from the beginning, the lesion had developed into an ulcerative and infiltrative type esophageal carcinoma.

　The patient had no complaints until quite recently. It was shown that the evolution of this case was very slow when the depth invasion was within the intraepithelium or up to the level of the muscularis mucosa, but its growth was fast when it invaded deeper than the submucosa. At the same time, we observed the change to malignancy of a gastric adenoma in the course of seven years and two months.