食道噴門腺由来と考えられた早期食道腺癌の1例

Esophageal adenocarcinoma, Report of a Case

要旨　患者は64歳，男性．自覚症状なし．近医の上部消化管内視鏡検査にて，SCJ（squamocolumnar junction）近傍に隆起性病変を指摘され，精査加療目的で当院へ紹介された．食道X線検査では食道胃接合部（esophagogastric junction ; EGJ）に長径10mmの分葉状の隆起性病変として描出され，食道内視鏡では一部表面に白苔を伴う発赤調の亜有茎性隆起であった．周囲の粘膜にはSSBE（short segment Barrett esophagus）を伴っており，前医での生検で分化型腺癌が検出されていたため，Barrett食道腺癌と術前診断し，内視鏡的粘膜下層剝離術（endoscopic submucosal dissection ; ESD）にて切除した．病理組織学的には深達度MMの高分化腺癌であった．切除標本の病理組織学的所見では，Barrett上皮との連続性はなく，切除標本における肉眼的形態や，粘膜固有層～粘膜深層を主座として食道噴門腺やその導管に類似した腺管形態を示したことから食道噴門腺に由来する原発性食道腺癌と推測された．

　A man in his sixties without symptoms in whom GI（gastrointestinal）endoscopy had revealed an elevated lesion at the SCJ（squamocolumnar junction）vicinity, was referred to our hospital. X-ray examination revealed a lobular elevated lesion of longer axis 10mm at the EGJ（esophagogastric junction）, and it was reddish sub-pediculately elevated lesion with fur on the portion surface by upper GI endoscopy. There were SSBE（short segment Barrett esophagus）on the SCJ, and the biopsy specimen revealed well differentiated adenocarcinoma. The elevated lesion was diagnosed as adenocarcinoma in the Barrett esophagus preoperatively. ESD（Endoscopic submucosal dissection）was performed. The pathological diagnosis was a well differentiated adenocarcinoma, and the tumor was located in the muscularis mucosae（MM）. The tumor was not continuity with Barrett esophagus and multiplied it while forming similar architecture in esophageal cardiac gland, and diagnosed as the primary esophageal adenocarcinoma which showed differentiation determination to esophageal cardiac gland.