早期食道癌を合併した食道壁内偽憩室症の1例

Detailed Examination of Surgical Specimens Showing Multiple False Diverticulosis of the Esophagus and Esophageal Intramural Pseudodiverticulosis Complicated by Early Esophageal Cancer, Report of a Case

要旨●患者は60歳代前半，男性．嚥下時つかえ感に対しての食道X線造影検査，上部消化管内視鏡検査にて，多発性の食道憩室と不整食道粘膜を認めたため，食道壁内偽憩室症に合併した食道癌と診断し，食道癌治療目的に外科的切除術が施行された．手術標本を病理学的に詳細に検討してみると，憩室様構造は全部で88個あったが，食道腺導管の異常な拡張である食道壁内偽憩室症と呼べるものは20個のみで，それ以外の68個は粘膜筋板を欠損した仮性憩室であった．さらに仮性憩室周囲には異物性肉芽腫が散見され，縦走傾向の配置にある食道憩室と癌の局在に関連性が示唆され，癌の成り立ちを考えるうえで興味深い症例であった．

　A 64-year-old man presented with difficulty in swallowing. He was diagnosed with EIPD（esophageal intramural pseudodiverticulosis）complicated by early esophageal cancer on the basis of esophagoscopic and esophagographic findings with reference to the existing reports. We detected a total of 88 diverticulum-like structures on detailed examination of the resected surgical specimen obtained after the patient underwent surgery for esophageal cancer. Only 20 of the 88 structures were intramural pseudodiverticula, i.e., abnormal dilations of the esophageal glands; the other structures were false diverticula that lacked muscularis mucosa. Foreign body granulomas were observed around the false diverticula. In addition, the esophageal cancer was confined to the epithelium.