0-Ⅱc（sm）型から急速に形の変化した0-1＋Ⅱc型食道表在癌の1例

Esophageal Cancer of Superficial and Slightly Depressed Type Rapidly Developing into Superficial and Protruding Type, Report of a Case

要旨　患者は63歳，男性．胃集検で食道病変を指摘された．初回内視鏡検査では，上切歯列から27～33cmの前壁を中心とした0-Ⅱc型，中央部は粗大顆粒状の辺縁隆起を伴った陥凹であり，0-Ⅱc（sm）型と考えられた．2か月後の内視鏡検査で，病巣の一部に丈の高い隆起が出現し0-Ⅰ＋Ⅱc型に変化した．X線検査で0-Ⅰ部分は著明なひだ肥厚様の透亮像として描出され，深達度sm2と推定された．病理所見は，5.5×5.2cmの0-Ⅰ＋Ⅱc型，深達度sm3，中分化型扁平上皮癌，ly2，v1，n4(＋)．0-Ⅱc病変の粘膜下層浸潤に伴い，0-I型の隆起が出現した症例であり，初回検査時の“壁を弛緩させると一部がわずかに盛り上がる所見”は粘膜下層浸潤を示唆すると考えられた．

　The patient was a 63-year-old man whose lesion was picked up during a gastric mass survey. Initial endoscopy revealed a slightly depressed lesion at the anterior wall of the thoracic esophagus and 27～33 cm from the incisors. Because of moderate depression with demarcated granules and marginal elevation, the lesion was recognized as superficial and slightly depressed (0-Ⅱc) type cancer with invasion into the submucosa. In two months, a part of the lesion had grown rapidly to become a marked protrusion, and so the type 0-Ⅱc lesion changed into the type 0-Ⅰ+Ⅱc. Radiologically the lesion showed a distinct protrusion which appeared with markedly thickened folds, and the invasion was estimated to be into the middle third of the submucosa. Pathologically it was a type 0-Ⅰ+Ⅱc lesion measuring 55 X 52 mm in size. It was a moderately differentiated squamous cell carcinoma invading into the deeper third of the submucosa, ly2, v1, and n4(+).

　Considering the facts that type 0-Ⅱc lesions account for 67% of all esophageal mucosal cancers, type 0-Ⅰ account for 59% of submucosal cancers, and ulcerative type account for 85% of advanced cancers, a type 0-Ⅱc lesion may develop into an ulcerative advanced cancer. The partial protrusion according to Taxation of the esophageal wall at the initial endoscopy probably foreshadows cancer invasion into the submucosa.