Barrett食道に発生した食道表在腺癌の1例

Superficial Adenocarcinoma Arising from Barrett's Esophagus, Report of a Case

要旨　患者は54歳，女性で，数年前，他院にて内視鏡検査を施行され食道裂孔ヘルニアと診断された．今回は継続する胸やけを主訴に胃X線検査を施行され，胸部下部食道（Ei）後壁寄りに結節状および顆粒状小隆起の集籏した病変を指摘され，当院に紹介された．食道内視鏡では上切歯列より35～41cmの部位に全周性に発赤した毛細血管網を透見しうるビロード状粘膜を認め，その後壁を中心にほぼ半周にわたり周辺粘膜より更に発赤の強い，周辺にびらんを伴う凹凸不整な隆起病変を認め，滑脱型食道裂孔ヘルニアを伴うBarrett食道に発生した深達度sm，0-Ⅰ＋Ⅱa型の食道腺癌と診断した．組織学的には中分化型管状腺癌，深達度sm，n₀，ly(＋)であった．本邦におけるBarrett食道に発生した表在型腺癌の報告例15例につき検討を加え報告した．

　A 54-year-old female with a complaint of heartburn was referred to our hospital in September 1991. For the past several years, she had noticed frequent burning sensation on the chest and regurgitation of sour liquid to the mouth, and was diagnosed as a sliding hiatal hernia in 1987. Upper GI x-ray examination revealed postural regurgitation and an irregularly elevated lesion whose surface was granular and nodular. Endoscopic examination showed smooth-surfaced erythematous mucosa and a more erythematous granular lesion at the distal esophagus. Histologically, this lesion was moderately differentiated adenocarcinoma arising from columnar epithelium of the esophagus (Barrett's esophagus) associated with hiatal hernia. The lesion was limited with in the submucosal layer.