ヨード染色で初めて明らかとなった0-Ⅱb型食道表在癌の1例

0-Ⅱb Type Superficial Esophageal carcinoma: For the First Time Recognized by Chromoendoscopy Using Iodine Staining, Report of a Case

要旨　患者は嗄声を主訴としてその精査のために上部消化管内視鏡検査が施行された60歳の男性．長期にわたる比較的多量の喫煙歴，飲酒歴を有する．通常の内視鏡観察では明らかな病変を指摘することができなかったが，ヨード染色を施行し初めて上門歯列から28cmの部位に長径1.5cm大の境界明瞭な不染帯を認めた．0-Ⅱb型，深達度m1の食道粘膜癌と診断し非開胸食道抜去術が施行された．病理組織標本では，病変全体にわたり脚釘の延長を認めるが，ほぼ基底膜は保たれており，基底層型を主体とし一部全層性に置換される深達度m1の高分化から中分化型の扁平上皮癌であった．リンパ管侵襲，静脈侵襲，ともに認められなかった．

　60-year-old man complaining of hoarsenes was visited to our hospital for further examination. Ordinary examination of upper gastrointestinal endoscopy could not detected the apparent abnomality in the esophagus, but after the iodine staining a well demarcated small unstaring area, 1.5 cm in size, was detected at the 28 cm from upper incisor. We diagnosed this lesion as 0-Ⅱb type superficial esophageal caricinoma. Transhiatal resection of the esophagus was performed. Pathological study of the resected specimen reveled a squamous cell carcinoma limited to the basal portion of the epithelium. He died of leukemia at four years after operation. 0-Ⅱb type superficial esophageal caricinoma is so call truly early esophageal carcinoma. Becouse most of this lesion, depth of invasion limited to the m1, vessele invasion, lymph node metastasis are very rare, and prognosis is excellent after resection.