貯留嚢胞を合併した表層拡大型食道sm癌の1例

Superficially-spreading-type Esophageal Cancer with Retention Cyst, Report of a Case

要旨　患者は56歳，女性．喫煙歴は20本/日×30年，飲酒歴は日本酒2合/日×30年．内視鏡検査で，胸部中部食道に全周性で長径7cmにわたる発赤した浅い陥凹性病変を認めた．病変内の前壁～左壁側に粘膜下腫瘍様の〔隆起 A〕が存在し，その隆起の口側は表面が粗大結節状だが肛門側は平滑であった．後壁側にも〔陥凹内隆起 B〕が存在した．胸部下部食道には直径2cmのIIc病変を認めた．表層拡大型食道sm癌と診断し，食道亜全摘術を施行した．病理組織学的には前者は52×50mm，Ip＋IIc型の扁平上皮癌でNo. 7のリンパ節に転移を認めた．〔隆起 B〕でsm浸潤していたが，〔隆起 A〕は貯留嚢胞による隆起が主体で癌はsm1にとどまっていた．癌の上方発育により食道腺の導管が閉塞し貯留嚢胞が形成された可能性が示唆された．貯留嚢胞を合併した食道癌は世界で2例目である．

　A 56-year-old woman underwent conventional endoscopy for the purpose of screening and it showed esophageal tumor. Double contrast radiograph and endoscopy revealed superficially-spreading-type esophageal cancer with two nodular lesions at the middle thoracic esophagus. The nodular lesion A on the left wall was covered with rough mucosa on the oral side and with smooth mucosa on the anal side. Chromoendoscopic findings using iodine staining showed an unstained area involving the entire circumference of the esophagus, measuring 5 cm in length. Subtotal esophagectomy was performed. The resected specimen revealed a retention cyst under the nodular lesion A. Some ductal involvements were also seen, which were suspected to have contribute to the development of a retention cyst. This is only the second case of esophageal carcinoma with retention cyst to be reported in world medical literature.

　1) Department of Internal Medicine, Harima Hospital of Ishikawajima-Harima Heavy Industries, Health Insurance Society, Aioi, Japan

　2) Second Department of Pathology, Hyogo College of Medicine, Nishinomiya, Japan