Barrett食道腺癌の2例

Two Cases of Adenocarcinoma Arising in Barrett's Esophagus

要旨　Barrett食道からの発生が考えられる食道腺癌を2例経験した．〔症例1〕は60歳の男性，〔症例2〕は69歳の女性．2例ともに食道裂孔ヘルニアを伴い，主病巣はIm・Ei，約5cm，全周性の表在隆起型で，前者はsmに限局する高分化型腺癌，後者はpmまで浸潤するadenocarcinoma muconodulareであった．円柱上皮は共通してmetaplastic specialized columnar epitheliumを形成し，島状に扁平上皮の残存と，円柱上皮下に固有食道腺の存在を認め，後天的な成因が考えられた．Barrett上皮の定義を病理学的criteriaと内視鏡診断の二面から整理し，またBarrett上皮のfollow-upにおけるdysplasiaの問題について考察を加えた．

　Two cases of adenocarcinoma arising in Barrett's esophagus treated in our surgical department are studied both clinically and pathologically, in order to define an acquired Barrett's esophagus, and to clarify a controversial point concerning dysplasia as a precancerous lesion.

　Case 1 was a 60-year-old man complaining of breath odor, and Case 2 was a 69-year-old woman complaining of dysphagia. Clinical examinations in these two cases revealed numerous nodular lesions beyond the squamocolumnar junction and a complication of hiatal hernia. In Case 1, a blunt dissection of the esophagus without thoracotomy was performed because of his reduced pulmonary function, and in Case 2, retrosternal esophagogastrostomy was performed through the right thoracic approach.

　The gross specimens of both cases revealed multiple Ⅱa-like elevated lesions, measurig 35 × 45 mm (Figs. 3, 4) and 40 × 45 mm (Figs. 8, 9) respectively. Microscopically, in Case 1, well differentiated adenocarcinoma was found to have infiltrated only the submucosal layer (Fig. 5), and in Case 2, mucoid adenocarcinoma had invaded the proper muscle layer (Fig. 10 a-d). These two cancers were replaced by metaplastic specialized columnar epithelium. Case 1 died of pulmonary and renal failure postoperatively, and Case 2 has been asymptomatic without evidence of recurrence for the last four years and three months.