Barrett食道に発生した食道腺癌の1例

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

要旨　患者は71歳，男性．約10年来の胸やけ，上腹部不快感を主訴に近医を受診，上部消化管X線検査で胃に異常を指摘され新小倉病院を紹介された．1999年6月の内視鏡検査では最長4cmのBarrett食道を指摘され，Barrett食道内に境界不明瞭な微細顆粒状のわずかな粘膜肥厚が認められた．0-Ⅱa型のBarrett食道腺癌を疑い生検したが高度異型腺管は認めるものの癌とは診断されなかった．2000年3月の内視鏡検査では腫瘍は軽度発赤し，顆粒状でわずかに隆起し緊満感を伴っていた．生検組織は高分化型腺癌でありBarrett食道腺癌と診断した．X線検査では約7mmの小顆粒の集簇したわずかな隆起として描出された．以上より深達度MのBarrett食道腺癌と診断した．重篤な合併症を有する患者であったため治療は内視鏡的粘膜切除術を行った．病理組織学的には大きさ6×5mm，肉眼型0-Ⅱa型，腫瘍の一部が粘膜筋板に浸潤する深達度m3の高分化型腺癌であった．

　A 71-year-old male visited our hospital with the complaint of heart burn and upper abdominal discomfort. Initial endoscopic examination (Jun. 23, 1999) revealed a hiatus hernia and a columnar-lined epithelium extending to 4 cm forward to the oral side from the esophagogastric junction. On the proximal part of the epithelium, slightly thickened mucosa with fine granular surface was observed adjacent to the squamocolumnar junction. These features suggested early adenocarcinoma originating in Barrett's esophagus, but the biopsy specimen was insufficient for a diagnosis of carcinoma. On a follow-up endoscopic examination, performed 9 months later (March, 2000), the tumor had reddened and expanded a littie more than previous condition. In the esophagogram, the tumor was slightly elevated with a fine granular surface and measured 7 mm in diameter. Rebiopsy was performed and, finally, the tumor was diagnosed as a well-differentiated adenocarcinoma (0-Ⅱa), originating in Barrett's esophagus. The patient was treated with endoscopic resection because of other complications (angina pectoris, bronchial asthma). The histological examination of the resected specimen showed a well differetiated adenocarcinoma, measuring 6 × 5 mm, which had focally invaded the muscularis mucosa and reached beneath the squamous epithelium. No definite submucosal invasion was recognized.