生検病理診断が経時的に変化したヨード不染帯の1例

A Follow-up Case with Esophageal Area Unstained by Iodine, Report of a Case

要旨　患者は72歳，男性．スクリーニング検査として上部消化管内視鏡検査が行われた際に食道上部に不染帯が発見された．生検所見で異型性が認められなかったため，経過観察となった．その後の生検所見でdysplasiaと診断され，最終的にsquamous cell carcinomaと診断されたために内視鏡下粘膜切除が行われた．切除標本の再構築像では異型性のheterogeneityが認められた．本症例はヨード不染帯の経過観察例であるが，経過観察中に生検所見でdysplasiaとされた場合，積極的な内視鏡下粘膜切除を行い病変全体の組織学的検討をすべきであると考えられた．

　The patient was a 72-year-old man who underwent screening endoscopic examination, which revealed an area unstained by indine of the esophagus. Conventional endoscopic examination showed no abnormality in the esophageal mucosa. Histological examination of the biopsy specimen showed squamous epithelium without atypia. A biopsy specimen nine months after the first endoscopic examination revealed“dysplasia”, histologically. Finally, Endoscopic esophageal mucosal resection was performed because histological diagnosis from the biopsy specimen of the fourth endoscopic examination indicated squamous cell carcinoma. Although every part of the area unstaind by iodine in the resected specimen showed squamous cell carcinoma, heterogeneity was observed in terms of histological atypia. Endoscopic mucosal resection and histological examination for the whole area unstaind by iodine are recommended when a biopsy specimen reveals“dysplasia”, histologically.