ly（－）でリンパ節転移を認め根治切除後に遠隔転移を認めた食道m3癌の1例

An Esophageal Mucosal Carcinoma〔ly(-)〕Underwent Esophagectomy which Presented Lymph Node Involvement and Later Pulmonary Metastasis

要旨　EMR後根治切除術を施行した食道癌m3症例でリンパ節転移陽性であり，さらに根治切除術後3年で右肺下葉に転移を認めた症例を経験した．患者は65歳，男性．術前診断Mt，0-Ⅱc．まずEMR（分割切除）施行した．切除標本では2mm間隔の53切片中，大部分はep・m2であったが，2切片の切除断端の1部分でm3であった．右開胸開腹食道全摘術，3領域リンパ節郭清術を施行し，右反回神経沿線に1個リンパ節転移を認めた．術後46GyのT字照射を施行．根治切除術後3年に右肺下葉に転移が出現し，化学療法を施行したが，縮小を認めず，同部位の契状切除術を施行した．m3症例に対するリンパ節郭清の必要性を示唆すると考えた．

　A description is made of a case of a 65-year-old male with esophageal mucosal squamous cell carcinoma who presented lymph node involvement and later pulmonary metastasis. Esophagoscopy demonstrated a slightly depressed reddish lesion in the middle-third of the esophagus. It was 40 mm in length and occupied half the circumference of the esophagus. The lesion was resected, using the endoscopic mucosal resection (EMR) method into seven pieces. These were divided into 53 partitions for histopathological examination. Though, carcinoma cells were confirmed in 25 of these partitions, they were confined to the lamina propria mucosa except for two of them, in which the muscularlis mucosa was involved (m3) in a droplet-infiltration pattern. Neither lymphatic nor vessel invasion was found. Since these findings suggested considerably high possibility of lymph node involvement, the patient underwent esophagectomy with systematic lymph node dissection. Of 123 resected lymph nodes, carcinoma involvement was found in only one lymph node beside the recurrent nerve.

　Postoperatively, he received 46 Gy radiation therapy. A metastatic lesion was found in the right lung on CT three years after the esophagectomy, Though he was treated with chemotherapy followed by wedge resection of the involved lung, he developed pulmonary hilar recurrence and died eight months after the pulmonary resection.