0-Ⅱc型・Ul（＋）のBarrett食道癌の1例

Early Adenocarcinoma in Barrett's Esophagus, Type 0-IIc・Ul(＋), Report of a Case

要旨　患者は67歳の男性で，胸やけを主訴に受診，上部消化管内視鏡で食道病変を指摘された．X線，内視鏡上，裂孔ヘルニアが認められ，上切歯列38cmに，辺縁に浮腫状の隆起成分を有する潰瘍病変を認めた．また，上切歯列35cmまで，舌状に拡がる発赤粘膜を認め，1時から4時の領域では粘膜は厚ぼったく，なだらかな凹凸を有していた．陥凹病変，および口側の発赤粘膜からの生検組織から腺癌が得られ，早期Barrett食道癌と診断された．病理組織学的所見では，主病変の口側の発赤したBarrett上皮も粘膜癌であり，全体の病変の大きさは34×26mmであった．病巣内には扁平上皮の遺残，および食道固有腺を認めた．組織診断は高分化型腺癌で，深達度はSM2，ly₀，v₀，n₀であった．癌としての確定診断，および範囲の同定は画像所見のみからは，やや困難であった．

　A 67-year-old man visited our hospital with the complaint of heart burn. Barium esophagograms revealed evidence of hiatus hernia, and a slightly elevated lesion with a central barium fleck on the right anterior wall of the lower thoracic esophagus. Surrounding mucosal irregularity was observed. Endoscopic examination revealed a depressed lesion with a marginal elevated component. On the oral side of the main lesion, reddish and rough mucosa with maple-leaf-like shape which was able to be diagnosed as Barrett's epithelium was observed. Biopsy specimens sampled from the main lesion and the oral side lesion were diagnosed as well differentiated adenocarcinoma, and an operation was performed. Histological examination of the resected specimen showed a well-differentiated adenocarcinoma. 34 × 26 mm in size. Thre was invasion of sm2 but no lymph node metastasis. Islets of esophageal gland and squamous cell epithelium were observed beneath the main IIc lesion. Goblet cell metaplasia was observed in a large part of the surrounding columnar epithelium, and scattered dysplastic lesions were also found.