まれなpT1a低分化表在型Barrett食道腺癌の1例

Superficial pT1a-DMM Barrett's Adenocarcinoma with Solid Growth Pattern and Poor Differentiation in Short-Segment Barrett's Esophagus, Report of a Case

要旨●患者は60歳代，男性．定期的EGDにて食道胃接合部に径8mm大の淡い発赤調を呈する軽度隆起性病変を認めた．通常観察では，表面は比較的平滑で薄い白苔が付着していた．NBI拡大観察では，樹枝状かつ網状の血管を認め，一部network状に存在する血管も確認した．切除標本の病理診断は深達度pT1a-DMMで，線維性間質に乏しい充実性の純粋低分化腺癌であった．表在型Barrett食道腺癌では純粋な低分化腺癌は極めてまれであるが，表面が平滑で構造が不明瞭かつ樹枝状・網状血管，さらにnetwork状の血管を呈することが充実性低分化表在型Barrett食道腺癌を診断するうえで有用な所見と考えられた．

　A male in his sixties undergoing conventional esophagoscopy for surveillance was found to have a shallow 8mm elevated lesion with a marginal elevation at the esophagogastric junction. Conventional endoscopy showed that this lesion had a flat surface covered with thin whitish mucus and irregular microvessels with branched and reticular patterns or a network-like pattern. The endoscopicopically resected specimen was diagnosed as a poorly differentiated adenocarcinoma invading DMM with a solid growth pattern. Although this histological type is very rare in superficial Barrett's adenocarcinoma, in the case of this lesion with an unclear surface pattern that shows a smooth surface and corkscrew-like/network-like microvessel pattern, a differential diagnosis of a poorly differentiated adenocarcinoma may be important.