0-Ⅱc型を呈した表層拡大型食道粘膜癌の1例

Type 0-Ⅱc Superficial Spreading Mucosal Carcinoma of the Esophagus, Report of a Case

要旨　患者は61歳，男性．健康診断の食道X線検査で食道の異常を指摘された．入院後の食道X線検査では，壁不整像とバリウムの粘膜付着異常を伴った陥凹性病変が認められたが，壁の伸展性は比較的良好であった．内視鏡検査では，ほぼ全周性に粘膜の発赤を伴う浅い陥凹と一部に白色調の小顆粒状隆起が認められ，推定壁深達度はm2と考えられた．切除標本では大きさ7.2×4.6cm，0-Ⅱc型であった．病理組織学的所見では深達度m2の粘膜癌であったが，ほとんどは上皮内癌であり，m2の浸潤範囲は10％以下であった．発生学的には広範囲の粘膜が一斉に癌化を呈した症例と考えられた．本症例のように深達度が粘膜固有層にとどまる表層拡大型食道粘膜癌では，リンパ節転移や脈管侵襲は少なく予後良好と考えられた．

　The patient was a 61-year-old man who during a routine esophagogram, was found to have an esophageal disorder. Reexamination of the esophagogram revealed a marginal irregularity of the esophageal wall and slightly depressed lesions with faint barium spots. However, the elasticity of the esophageal wall was preserved. Esophagoscopy showed a superficially erosive lesion with a partially white fine granular surface. The lesion was probably confined to the mucosae. The histopathologic examination of the resected specimen revealed type 0-Ⅱc carcinoma, measuring 7.2 × 4.6 cm in size. Although cancer had invaded the lamina propria mucosae (m2), most of the lesions were intraepithelial cancers and the ratio of m2 was less than 10%. Etiologically, it was suspected that the esophageal epithelium had extensive carcinogenesis simultaneously. Since few patients with superficial spreading type cancer with tumor limited to the lamina propria mucosae have lymph node metastasis, their prognosis is good.