ヨード染色法により経過観察が可能であった0-Ⅱc型食道表在癌の1例

Type 0-Ⅱc Superficial Esophageal Carcinoma Followed Up Endoscopically for 26 Months, Report of a Case

要旨　長径6mmのヨード不染帯に対し26か月間の内視鏡的経過観察を行い，最終的に内視鏡的粘膜切除により，深達度m1の0-Ⅱc型食道粘膜癌と確認した症例を経験した．経過観察中に陥凹の出現と陥凹内の微細な樹枝状血管網の増生が認められ，0-Ⅱc型表在癌のごく初期の内視鏡像と思われる所見が得られた．本例を含めた経過観察食道粘膜癌9例と異型上皮1例を対象として，粘膜内癌の発育進展に関する形態的・時間的変化について検討した．

　A 78-year-old man visited to our endoscopy center for upper gastrointestinal examination in March, 1993. Endoscopical examination of the esophagus with iodine staining showed an irregular-shaped, well demarkated, non-stained lesion measuring about 6 mm in diameter. The lesion was visible only under iodine staining. For this reason, we decided there was no immediate necessity for treatment of this esophageal lesion. During a follow-up peried of 26 months we made six endoscopic examinations, until the iodine non-stained lesion became visible by normal viewing. The lesion became slightly reddished in color with abnormal vessels, hyperplasia, and slightly depressed configuration. By endoscopy, we diagnosed this lesion as type 0-Ⅱc superficial esophageal carcinoma. Endoscopic mucosal resection was performed. Pathological examination of the resected specimen revealed a squamous cell carcinoma limited to the basal portion of the epithelium, and without vessel invasion. This case revealed the very early appearance and the development of a type 0-Ⅱc superficial esophageal carcinoma. We would like to emphasize the usefulness and importance of the iodine staining method in esophageal endoscopic examination.