食道・胃の多発早期重複癌の1例

Multilpe Early Cancers of the Esophagus and Stomach, Report of a Case

要旨　早期食道癌の大部分は自覚症状のないまま検診や胃病変の精査，経過追跡の内視鏡検査で発見されている．本症例も検診の胃X線検査で異常を指摘され，その精査を目的に来院した．そして，その経過追跡中に初回検査では指摘されなかった食道と胃の別の部分に早期癌が発見され，最終的には食道・胃の重複癌でともに多発早期癌と診断された．そして，その経過を振り返るとわれわれが日常行っている内視鏡検査における種々の問題について示唆に富む1例と考えられた．

　A 59-year-old male visited our hospital for further examination in June 1988. On the first examination, multiple gastric ulcer scars near the cardia were detected. Because, endoscopically, the lesion was suspected to be Ⅱc type early gastric cancer, the patient was followed up, though the biopsy specimen showed only regenerative change. In March 1990, an erosive lesion was detected in the middle thoracic esophagus and its biopsy specimens showed severe dysplasia with suspicion of carcinoma in situ. In May 1992, small Ⅱc type early gastric cancer was detected on the angle and the biopsy specimens taken from the esophagus showed carcinoma in situ. In July 1992, endoscopical mucosal resection for gastric cancer was performed and histopathological examination showed well differentiated tubular adenocarcinoma mesuring 3 mm, with mucosal invasion. In Nov. 1992, surgical resection for esophageal cancers was performed. Histopathological examination showed two epithelial cancers (type 0-Ⅱc, 0-Ⅱb) and multiple dysplastic lesions in the esophagus, and mucosal cancer in the gastric mucosa on the anal margin of the resected specimen. Finally, two esophageal and two gastric early cancers were detected in the case.

　Thinking about the course of this case, we can learn some important points for examination. To detect early cancers, careful observation and correst biopsy in routine or follow-up examination is most important. To detect superficial flat type of esophageal cancers, routine iodine spray technique is especially useful in elder male patients.