EMR後に頸部，上縦隔リンパ節再発，肺転移を来したsm1食道癌の1例

Metastasis to the Upper Mediastinal Lymph Nodes and Lung after EMR of sm1 Esophageal Cancer, Report of a Case

要旨　患者は68歳，男性，内視鏡検査で胸部中部食道に0-Ⅱc病変を指摘された．術前検査で深達度m3と診断，画像診断にて明らかなリンパ節転移の所見もなく内視鏡的粘膜切除術（EMR）を施行した．切除標本の病理組織所見では中分化型扁平上皮癌，深達度は小範囲でsm1，ly₁の診断であった．患者に説明，同意の上，追加治療は行わない方針とした．3年11か月目に頸部リンパ節腫大を自覚，胸部CTで上縦隔リンパ節転移，肺転移と診断された．化学療法を施行したが効果は認められなかった．病理解剖所見では食道に遺残病巣や他臓器の重複癌も認めず原発巣からの転移と診断した．EMR後のリンパ節，肺転移再発例を経験したので報告する．

　We report a case of metastasis to the upper mediastinal lymph nodes and lung after endoscopic mucosal resection (EMR) of esophageal cancer. A 68-year-old male patient presented a 0-Ⅱc lesion on the middle thoracic esophagus. It was found by endoscopic screening. The patient underwent EMR for this lesion thought to be m3 in depth, by endoscopy, without any lymph node metastases noticed by radiological examinations. Pathology of the resected lesion revealed a moderately differentiated squamous cell carcinoma reaching the sm1 at the subtle area with mild lymphatic invasion (ly₁) . Discussion with the patient resulted in there being no additional resection. The patient was followed up for 3 years and 11 months, when he complained of cervical lymph node swelling and recurrence was detected by CT. It was mediastinal lymph node metastasis and lung metastasis. Chemotherapy was conducted without any effect. Autopsy revealed that those metastases were derived from the primary lesion, and no residual lesion in the esophagus or double cancer in other organs was detected.