経過観察中に癌化した食道上皮内腫瘍の1例

Esophageal Intraepithelial Neoplasia Transformed into Cancer During Follow-up, Report of a Case

要旨●患者は70歳代，男性．嘔気，心窩部痛を主訴にEGDを行い，胸部下部食道に血管透見が低下した15mm大の境界不明瞭な白色調の平坦病変を認めた．ヨード撒布にて15mm大の境界明瞭な不整形の不染帯を呈し，扁平上皮癌が疑われたが，生検病理診断は上皮内腫瘍であった．4年3か月後のEGD所見に大きな変化はなかったが，生検病理診断が扁平上皮癌となり内視鏡的切除を行った．最終病理診断はpT1a（EP）の扁平上皮癌であった．内視鏡診断では扁平上皮癌を疑うが，生検病理診断が上皮内腫瘍である場合，扁平上皮癌が併存する，あるいは扁平上皮癌に進展する可能性があり，病理医とのディスカッションのもと，診断的治療としての内視鏡的切除も検討する必要がある．

　The patient was a man in his 70s. Esogastroduodenoscopy was performed due to complaints of nausea and epigastric pain, and a 15mm-large whitish-flat lesion with decreased vascular permeability was found in the lower thoracic esophagus. Squamous cell carcinoma was suspected, and the pathological diagnosis of the biopsy specimen was intraepithelial neoplasia. Four years and three months later, EGD showed no significant change in the endoscopic findings ; however, the biopsy pathological diagnosis was squamous cell carcinoma, and endoscopic resection was performed. The final pathological diagnosis was squamous cell carcinoma of pT1a（EP）. When the endoscopic diagnosis is squamous cell carcinoma and the biopsy pathological diagnosis is intraepithelial neoplasia, there is a possibility that squamous cell carcinoma may coexist or intraepithelial neoplasia may develop into squamous cell carcinoma. It is important to discuss with the pathologist and consider endoscopic resection as a diagnostic treatment.