レ線追跡調査により発見された表層拡大型早期食道癌の1例

A Case of Superficial Spreading Type of Early Cancer of the Esophagus Detected by Roentegenographic Follow-up

　近年，消化器癌の早期発見，早期治療の概念が普及し，胃癌においては多数の早期胃癌症例が集積され，その治療遠隔成績が非常に良好であることが報告されている¹⁾．しかし食道癌に関しては進行癌がほとんどであり，それの早期癌症例は1970年鍋谷の集計28例²⁾と，その後の報告例を加えても30数例^3)～5)にすぎない．最近，筆者らは約1年間の愁訴が続いた症例で，頻回のレ線検査により食道の異常を指摘されて，食道ファイバースコープ，生検により確認しえた表層拡大型ともいいうる広範な早期胸部中部食道癌を経験したので報告する．

症例

　患　者：K. Y.　68歳，♂　ボイラーマン．

　家族歴：既往歴ともに特記すべきことなし．

　嗜好品：酒1日約2合，煙草1日約20本．

　主　訴：えん下障害．

　現病歴：昭和45年11月頃より，水を飲んだり，食事をした時に胸骨後部でしみる感じがした．その後症状は持続し，昭和46年初め頃よりえん下障害が加わってきた．某医で同年3月31日食道胃レ線透視をうけたが，異常所見はないといわれた．しかし依然としてその愁訴は持続したので，8月31日再度の食道透視をうけたが，やはり異常を指摘されなかった．9月1日3回目の透視の結果，中部食道の不整陰影を指摘されて本院内科を紹介され，再度にわたる食道精査をうけたが，何らそれをうらづけるものは指摘されなかった．しかし，その後も水を飲んだり，食事をした時にかえってえん下障害が増強し，10月2日および11月9日の透視の結果，最後に中部食道の異常所見を再指摘され，精査の目的で当科へ紹介されてきた．

　The concept of detection and treatment of cancer in the digestive tract in an early stage has so widely spread, especially in cancer of the stomach. Many cases of early gastric cancer are being accumulated with increasingly better end results. On the other hand, reports of early cancer of the esophagus have been regrettably few-only 30 so up to the present. Mostly it is not found until in an advanced stage, with corresponding poor prognosis.

　The patient here described had undetermined complaints pertaining to the upper digestive tract, lasting almost one year. During this period he had the esophagus examined five times by fluoroscopy. Finally an abnormality was pointed out, later to be confirmed as cancer of the esophagus by both esophagofiberscope and biopsy. Operation was accordingly done. Gross specimen of the resected esophagus showed a depressed type lesion, 6.0×3.0 cm in dimensions, extending transversely to the whole circumference of the wall, possibly to be called as superficial spreading type. Histology showed highly differentiated squamous cell carcinoma, partly invading the submucosa. One right cardiac lymph node was involved as well.

　What is of most diagnostic importance is that undetermined complaints continued to persist all through several roentgenographic follow-ups. Retrospectively investigated, a small lesion is to be recognized always at the same site, but we failed to grasp the whole picture, and we keenly felt how difficult it is to diagnose radiographically early depressed lesion of the esophagus. This case has given us a lesson, in that most patients with advanced esophageal cancer have undetermined complaints of several years' duration, and that we should never make light of subjective symptoms, but should follow up the course of disease with utmost care.