逆流性食道炎に随伴した食道扁平上皮papillomaの1例

Squamous Cell Papilloma of the Esophagus, Report of a Case

要旨　患者は70歳，女性．胸やけ，胃液の逆流症状あり．老人検診にて食道裂孔ヘルニアを疑われて，精査目的に来院した．上部消化管X線検査で中等度の滑脱型食道裂孔ヘルニアを認め，食道胃接合部に小隆起性病変を発見した．内視鏡検査では，明らかに挙上した食道胃粘膜接合部に接して半球状の隆起性病変があり，周囲にはびらん性，小潰瘍性病変が認められた．生検組織診断にて食道のpapillomaと診断した．食道炎の治療を開始したところ，粘膜病変は速やかに消退し，papillomaは縮小し，最終的には消失を確認した．

　A 70-year-old woman was referred to our hospital because of heartburn and regurgitation of gastric content to the pharynx. She had enjoyed good health until she fell off her bicycle seven years before. She had her back injured and it resulted in remarkable deformity of the spine. Thereafter, she began to suffer from occasional heartburn and regurgitation. The symptoms had worsened in the previous three months and she also suffered from loss of appetite. A moderate sliding hiatus hernia and a small elevated lesion at the distal esophagus was noticed during a barium study of the esophagus and the stomach. Endoscopy revealed a scar, small erosions and a small elevated mucosal lesion adjacent to the squamo-columnar junction. Histological studies on bite biopsy specimens from the elevated lesion revealed thickening of stratified squamous cell epithelium with slight esophagitis. Conservative treatment including proton pump inhibitor and prokinetics was conducted. Heartburn and regurgitation disapeared in several days. Endoscopy after one month revealed that the erosion had healed and the elevated lesion had decreased in size. Histological studies of the bite biopsy specimens from the elevated lesion revealed a thickening of the esophageal epithelium with elongation of papillae which was compatible with characteristics of squamous cell papilloma of the esophagus. This case suggested a role of esophagitis in the pathogenesis of squamous cell papilloma of the distal esophagus.