微小食道腺癌の1例

Microadenocarcinoma of the Esophagus, Report of a Case

　上部消化管癌の診断技術の進歩は目覚ましく，患者が進んで検査を受けるならば，早期癌の発見診断は，さほど困難なものではなくなってきた．しかし，この中でスキルスの早期診断および噴門部癌の早期診断は，必ずしも確立された診断法とは言えず，6ヵ月から1年後に見逃しに気付く症例を経験するのもまれではない．同様に下部食道癌の早期発見も容易ではなく，更に，食道癌の大部分が組織学的に扁平上皮癌であるので，早期食道腺癌の報告は極めてまれである．

　今回筆者らは食道胃接合部に発生した微小食道腺癌を発見したので，その診断過程およびその組織発生について検討し報告する．

　In spite of recent advances in diagnostic techniques of upper gastro-intestinal lesions, it is still difficult to diagnose lesions of the esophago-cardiac portion in early phase.

　Therefore, report of a case that was diagnosed preoperatively as carcinoma of the esophago-cardiac portion in early phase is not frequently encountered. Futhermore, adenocarcinoma of the esophagus is very rare, and at present, only two cases of primary esophageal adenocarcinoma in early phase have been reported. These adenocarcinomas measured about 2 cm in the largest diameter.

　A case of minute adenocarcinoma of the cardiac portion of the esophagus preoperatively diagnosed as such has been reported.

　The patient, a man aged 49, was endoscopically diagnosed as having a small elevated lesion with tiny erosions located in the cardiac portion of the esophagus, and the diagnosis of biopsy made was well-differentiated adenocarcinoma.

　In the surgical material, the adenocarcinoma measured 10×8 mm in dimensions and was limited histologically to the lamina propria mucosae. Squamous metaplasias of malignant tubuli were observed .in places. It has been interpreted that the adenocarcinoma has arisen from the cardiac gland in the lamina propria mucosae of the lower part of the esophagus.