逆追跡症例からみた食道癌の発育進展―X線像を中心に

Retrospective Study of Growth and Extension of Esophageal Carcinoma with Reference to Its X-ray Findings

要旨　東京女子医科大学消化器病センターにおいて切除時あるいは診断確定時より5か月～2年2か月遡った時点でのX線像の中に癌と診断しうる所見を読み取ることのできた食道癌13例についてそのX線像を中心に発育形態を中心に検討した．初回のX線像が表在平坦型～びらん様陥凹型と判定された症例6例中2回目以後のX線像で表在平坦型にとどまる症例は1例のみであり，表在隆起型となった症例2例，表在陥凹型を示した症例1例，鋸歯型など潰瘍型を示した症例2例である．表在隆起型の2例は陥凹像が出現し，表在陥凹型～鋸歯型を示している．表在陥凹型の4例は1例は表在陥凹型にとどまっているが，3例は鋸歯型へと進展している．X線像による深達度診断基準に基づきm癌と推定された症例が，sm癌にまで進行したと診断されるまでの期間は短い症例で7か月，長い症例で10か月である．6か月以上という比較的長期間にわたり，smにとどまっているものと思われる．smから外膜に達するまでは8か月から2年2か月と症例により差があるようである．表在平坦型・びらん様陥凹型などを示し，主に表層性に進展した症例は脈管侵襲も少なく，リンパ節転移も認めない．これに対して径の増大よりも，像が明瞭となり，深部への進展が窺われる症例は，いずれも遠隔リンパ節転移が存在する．

　The growth and extension of esophageal carcinoma was studied with special reference to x-ray findings.

　Of patients whose radiographic studies were done in from 5 to 26 months before the resection, or before a definite diagnosis was made at the Institute of Gastroenterology, Tokyo Women's Medical College, 13 cases had been suspected of having esophageal carcinoma by x-ray findings.

　Among six cases diagnosed as superficial flat and erosive depressed types on an intial x-ray examination, two cases developed into into the superficial elevated type, one case into a superficial depressed type and two cases into the serrated type while the remaining case was of the superficial flat type.

　Two cases were of the superficial protruded type at the initial x-ray examination, but developed into superficial depressed and serrated types characteristic of depressed lesions.

　Out of four cases of the superficial depressed type, three cases changed into the serrated type and one case remained as the same depressed type.

　When diagnosed by an x-ray finding based on “General rules for radiological studies on depth invasion”, it can be said that m-carcinoma changes into sm-carcinoma in seven to ten months. In general, sm-carcinoma does not invade beyond the submucosal layer within a six month period. It takes 6-26 months for sm-carcinoma to reach the adventitia.

　Generally speaking, the superficial flat type and the erosive depressed type, which usually spread superficially, seldom have either vessel invasion or lymph node metastasis.

　On the other hand, the ones with x-ray findings clearly showing deeply infiltrated carcinoma usually have lymph node metastasis.