食道アカラシアに合併した0-Ip型食道表在癌（癌肉腫）を認めた1例

Esophageal Carcinosarcoma Presenting with a Type 0-Ip Lesion Associated with Esophageal Achalasia, Report of a Case

要旨　患者は17歳時から食道アカラシアの既往のある60歳代の男性．食道X線造影検査では胸部下部食道が対称性に狭小化し，拡張した口側食道に楕円形で可動性を有する隆起性病変を認めた．内視鏡検査では狭窄部を中心とした白濁肥厚粘膜を背景とし，胸部下部食道に白色で可動性を有するIp型病変と，発赤調で地図状の浅い陥凹面や不整なびらんが多発していた．ヨード染色でも不染ないし淡染を呈した．病理組織学的には，Ip型病変は主に低分化型扁平上皮癌から成り，多彩な組織像を示す紡錘型腫瘍細胞を伴うことから，癌肉腫と最終診断した．多発する0-IIcないし0-IIb病変はpT1a-LPMまでの扁平上皮癌であった．食道アカラシアにIp型食道癌（癌肉腫）が合併した報告は極めてまれであり，報告した．

　A 61-year-old man with dysphagia was hospitalized. On esophagography, a symmetrical stenosis about 70mm in length was found in the lower esophagus. On the proximal side of the stenosis the protrusion was movabile. On esophagoscopy, a type 0-Ip protrusion with white coating and stalk located in the lower portion of the esophagus was noted. Furtheremore, multiple depressed lesions（0-IIc and 0-IIb）, which had irregular shapes, as well as erosions were seen throughout the esophagus. On chromoendoscopy using Iodine staining, multiple lugol-voiding lesions were observed. An esophagectomy with lymphnode dissection was carried out. On histology, the 0-Ip lesion was composed of poorly differentiated squamous carcinoma cells and various spindle cell carcinoma cells, so a diagnosis of carcinosarcoma was made. Typical histological findings of achalasia were observed at the stenosis. An association of carcinosarcoma as a type 0-Ip lesion with esophageal achalasia is very rare.