Barrett食道に発生した表在腺癌の1例

Superficial Adenocarcinoma Arising from Barrett's Esophagus, Report of a Case

要旨　患者は73歳，男性．逆流性食道炎，食道潰瘍の経過観察中に下部食道に異常を指摘されたため入院となった．食道X線では食道裂孔ヘルニアに連続して口側に全周性の粗糙な粘膜変化と，内部に淡い不整形の陰影斑を認めた．内視鏡では長径6cmに及ぶ発赤調で血管網を透見しうるビロード状粘膜と，異常粘膜局面の中央部には白苔に覆われた辺縁整の陥凹性病変を認めた．超音波内視鏡では陥凹部はUl-Ⅱの解放性潰瘍の所見であった．Barrett食道に合併したBarrett潰瘍として矛盾のない所見であったが，陥凹辺縁からの生検で腺癌が証明されたため，非開胸抜去術を施行した．組織学的にはBarrett食道に発生した深達度m1の高分化型管状腺癌で，陥凹部はUl-Ⅱの潰瘍であった．また，他部位には多発性に種々の異形成性のBarrett上皮を伴っていた．

　A 73-year-old male was admitted to our hospital for a precise diagnosis of the lower esophagus, where abnormal findings had appeared at a follow-up endoscopy for sliding hiatal hernia and reflux esophagitis. Double contrast radiography of the esophagus showed an uneven mucosa extending approximately 60 mm in length at the distal esophagus, and an irregular-shaped barium fleck was observed in the middle of the abnormal mucosa. Endoscopic examination revealed a smooth-surfaced erythematous mucosa with an irregular oral margin, in which there were some islets of normal mucosa, and a shallow depressed lesion covered with a white coat, which was judged as Ul-Ⅱ ulcer by endoscopic ultrasonography. Biopsy specimens from the edge of the depressed lesion proved it to be a well differentiated adenocarcinoma, and from the smooth-surfaced mucosa, a distinctive columnar epithelium was observed. On the diagnosis of superficial adenocarcinoma arising from Barrett's esophagus, surgical operation was performed. Histological examination of the resected specimen demonstrated a well differentiated adenocarcinoma arising from Barrett's epithelium, adjacent to a Ul-Ⅱ esophageal ulcer, and limited to the mucosa. In addition, there were some spots with various stages of dysplastic epithelium in other regions of Barrett's epithelium.