晩発性放射線性食道潰瘍の1例

Radiation Induced Esophageal Ulcer, Report of a Case

要旨　患者は77歳の女性，嚥下障害を主訴に来院．15年前，左乳癌により定型的乳房切断術と放射線照射を受けていた．上部消化管造影および内視鏡検査では頸胸境界部食道の右壁に粘膜下の要素をもつ隆起と小潰瘍を認め，1か月後には径約1cmの潰瘍となった．内科的治療に抗し，狭窄症状が高度なため切除再建術を行った．標本では潰瘍を中心とする長径約5cmの食道壁肥厚があり，組織学的には全層性に高度の線維化を認めた．また，細血管の増生，拡張が著明であったが，潰瘍の治癒傾向はみられず，これらの組織所見と既往歴から，晩発性の放射線性食道潰瘍と診断し，嚥下障害も筋層を含む高度の線維化による運動機能異常に基づくものと考えられた．

　A 77-year-old woman .was referred to us on Dec. 22, 1986 because of dysphagia and esophageal ulcer (Table 1). She had a previous history of left radical mastectomy for breast cancer, followed by postoperative ⁶⁰Co irradiation to parasternal and supraclavicular regions with 50 Gy about 15 years before.

　UGIs and endoscopy showed a small ulcer surrounded by submucosal tumor-like protrusion in the esophagus at the thoracic inlet (Fig. 1 a, Fig. 2 a, b). Examination one month later revealed the ulcer which became larger despite medical treatment, now measuring 1 cm in diameter (Fig. 1 b, 2 c). Severe dysphagia continued.

　Right thoracotomy and subtotal esophagectomy were performed on Jan. 13, 1987 (Fig. 4). Histological examination revealed nonspecific ulcer, 5 cm in diameter, surrounded by fibrous granulation tissue (Fig. 5 b, c). Proliferation of dilated capillary vessels was also seen in the bottom of the ulcer, the surrounding wall of which was free from remarkable infiltration of inflammatory cells (Fig. 5 d).

　Based on these findings and previous medical history, the patient was diagnosed as having a postradiation ulcer which appeared 15 years after irradiation. Dysphagia was considered due to esophageal dysfunction caused by severe fibrosis of the proper muscle layer.