急速な自然消退を示した食道表在癌の1例

Spontaneous Regression of Superficial Carcinoma of the Esophagus, Report of a Case

要旨　患者は65歳，男性．1993年5月，つかえ感と胸痛が出現し，近医で食道癌と診断された．6月4日の内視鏡検査ではIm左後壁に長径6cmの0-Ipl＋Ⅱc型表在癌を認め，易出血性の潰瘍面を伴っていた．7月2日には潰瘍面は消失し，0-Ⅰpl型（最大15×15mm，予想深達度SM2）の病巣が不連続に散在するようになった．その後，冠動脈造影検査のため一時退院した．8月18日の再入院時には口側の各隆起は更に縮小して0-Ⅱa型の多発病変に変わり，肛門側の病変は消失し，再生性の上皮が認められた．8月31日，手術を行った．切除標本では11×5mmまでの0-Ⅱaあるいは0-Ⅱc型の小病巣が6個確認された．深達度m3からm1までの低分化型扁平上皮癌で，ly0，V0，n0であった．

　A 65-year-old male visited a neighboring hospital with complaints of swallowing disturbance and retrosternal pain in May, 1993. He was diagnosed as having superficial carcinoma of the esophagus and sent to our hospital.

　On June 4, endoscopic examination revealed a type 0-Ipl+Ⅱc carcinoma on the left and posterior wall of the middle intra-thoracic esophagus and accompanied with easy-to-bleed ulcerative mucosa. On July 2, there were only several carcinomas of type 0-Ipl but no ulcerative lesions. He was admitted to our hospital in August, after some examinations concerning his coronary arterial disease. Then, with no treatment, each of the protruded carcinomatous lesions became smaller than they were one month before. The anal one, in particular, thoroughly disappeared and was replaced by regenerative epithelium.

　Subtotal esophagectomy through right thoractomy and retromediastinal esophago-gastrostomy were performed on August 31. Pathologically, there were six small carcinomas of type 0-Ⅱa and 0-Ⅱc, up to llmm in size. Every lesion was diagnosed as pooly differentiated squamous cell carcinoma, limited to the mucosa (m₁, m₂, or m₃). Neither vascular spreading nor lymph node involvement identified. In the neighboring area, extensive fibrotic changes were also found in the lamina propria mucosa and tunica submucosa.

　In this case, the carcinomatous lesion seemed regress or diminish spontaneously, which is very rare and seldom reported in the literature.