炎症性ポリープとの鑑別が困難であった表在型Barrett食道癌の1例

Superficial Cancer of Barrett's Esophagus was Difficult to Differentiate from an Inflammatory Polyp, Report of a Case

要旨●背景粘膜に逆流性食道炎を伴うSSBE内に発生した0-I＋IIb病変である．内視鏡的には積極的に癌を疑う所見が捉えられず，炎症性ポリープと診断したが，生検にて腫瘍の可能性を指摘され，全生検を目的にESDを施行した．病理学的に，0-I部分は炎症性ポリープとBarrett食道癌が混在する像で表層はびらんや肉芽組織で覆われており，口側のIIb部分は扁平上皮下を腺癌が進展する像をとっており，腫瘍の露出を認めず，癌としての診断には生検診断のみが有用であった．

　A stage 0-I＋IIb lesion developed in the short-segment Barrett's esophagus with reflux esophagitis in the underlying mucosa. Because no endoscopic findings were suggestive of cancer, the condition was diagnosed as an inflammatory polyp. However, a biopsy indicated the possibility of a tumor, and endoscopic submucosal dissection was performed for total biopsy. Pathology revealed images of an inflammatory polyp intermixed with Barrett's esophageal cancer in the 0-I portion, with inflammation and granulation covering the surface. The IIb portion on the oral side showed the progression of adenocarcinoma below the squamous epithelium. Because the tumor was not exposed, biopsy was the only means to diagnose the cancer.