内分泌細胞への分化を示したBarrett食道癌の1例

Adenocarcinoma with Endocrine Cell Differentiation in Barrett's Esophagus, Report of a Case

要旨●患者は50歳代，男性．上腹部痛のため近医で施行されたEGDでSCJ（squamocolumnar junction）に隆起性病変を認め，精査加療目的で当院に紹介され受診となった．食道X線造影検査では，長径約40mmの不整な丈の高い，結節状の隆起性病変で，側面像では陰影欠損を認めた．EGDでは，一部表面に白苔を伴う発赤調を呈し，太いくびれを有していた．周囲にはSSBE（short segment Barrett's esophagus）を伴い，前医生検で腺癌と診断されており，粘膜下層深部以深へ浸潤したBarrett食道腺癌と術前診断した．胸腔鏡下食道亜全摘・胃管再建・リンパ節郭清術を施行した．病理組織学的には，高分化管状腺癌成分と充実性の低分化腺癌成分から成るBarrett食道腺癌で，壁深達度はpT2（MP）であった．免疫組織化学染色検査で，病変肛門側で内分泌細胞への分化を認めた．内分泌細胞への分化を示したBarrett食道腺癌の1例を経験したので，文献的考察を加えて報告した．

　A 50-year-old man with a history of epigastralgia and an elevated lesion at the squamocolumnar junction, revealed using gastrointestinal endoscopy, was referred to our hospital. Subsequent esophagography revealed the presence of a lobular elevated lesion 40mm in length at the esophagogastric junction. Upper gastrointestinal endoscopy showed a reddish subpediculately elevated lesion with fur on its surface. An adenocarcinoma in short segment Barrett's esophagus had been diagnosed from a previous tissue biopsy. Following surgery, histological examination resulted in the diagnosis of well to poorly differentiated adenocarcinoma in Barrett's esophagus. The depth of the tumor was identified as pT2. Immunostaining results confirmed the presence of endocrine cell differentiation in a portion of the anal side of the lesion. In summary, this is a report of an adenocarcinoma with endocrine cell differentiation arising from Barrett's esophagus in a 50-year-old man.