潰瘍による狭窄，多発腺癌を合併したBarrett食道の1例

Barrett's Esophagus Associated with Chronic Ulcer and Multiple Early Cancers, Report of a Case

要旨　患者は71歳，男性．胸部つかえ感，胸やけを主訴に近医を受診し，食道癌を疑われて当科に紹介入院となった．食道胃透視で胸部下部食道の狭窄と狭窄部後壁に辺縁が平滑な陥凹を主体とした病変を指摘された．食道内視鏡では切歯より28～30cmの食道後壁に潰瘍形成を認め，生検でBarrett食道と診断された．ニッセン法による逆流防止手術を施行したが，円柱上皮は消退せず，4年後にBarrett潰瘍による食道狭窄の診断で胸部食道亜全摘術を施行した．摘出標本の詳細な病理学的検索で術前に発見できなかったⅡb型微小多発腺癌が合計4か所発見された．

　A 71-year-old man, with a longstanding history of retrosternal burning sensation, was pointed out to have a stenosis at the lower esophagus with hiatus hernia on radiologic and endoscopic examinations. Diagnosis of Barrett's esophagus was made based on the findings of columnar epithelium-lined mucosa similar to non-typical intestinal metaplasia. He underwent fundoplication to prevent reflux. Four years later, however, he developed severe dysphagia due to esophageal stenosis. Endoscopic examination revealed columnar epithelial lining in the distal 2/3 of the esophagus, where a deep ulcer and a stricture were identified. Thus, thoracic esophagectomy was carried out.

　Histological studies of the resected specimen demonstrated an esophageal ulcer (Ul-Ⅲ) and four minute lesions of well differentiated adenocarcinoma (Ⅱb type) scattered in the Barrett's esophagus.