9年5か月にわたりX線像を逆追跡できた食道癌の1例

Esophageal Carcinoma Traced Retrospectively On X-ray Films for Nine Years and Five Months, Report of a Case

要旨　70歳，男性．1年2か月前よりつかえ感が出現，1か月前には上腹部痛も加わるようになった．食道X線検査で進行食道癌が発見され，食道全摘術が施行された．組織学的には高分化型扁平上皮癌であり，深達度はa₁，上皮内伸展やリンパ節転移は認められなかった．食道X線写真を逆追跡すると，9年5か月前では病変を指摘できないが，4年1か月前では，わずかな大小不同の顆粒像と4cmにわたる壁の変形が認められた．壁の変形は2年3か月前では7cm，5か月前では10cmに達したが，表在癌と考えられる所見であった．これらのことより，食道癌の中には表在癌として長くとどまっているものがあると考えられた．

　A 70-year-old male had complained of dysphagia for one year and two months, and epigastralgia for one month. Barium examination of the esophagus revealed a spiral shape tumor 10 cm in length at the middle intra-thoracic esophagus (Figs. 1-3). Total esophagectomy was carried out. Histological examination showed a well differentiated squamous cell carcinoma invading as far as the adventitia (al) without intraepithelial spread and no lymph node metastasis (Figs. 5 and 6).

　Retrospectively we couldn't detect any abnormal findings on x-ray films taken 9 years and 5 months ago (Fig. 12). The x-ray films taken 4 years and 1 month ago revealed a marginal abnormality, 4 cm in length, at the right posterior wall of the middle intra-thoracic esophagus (Fig. 11). The length of the marginal abnormality grew up 7 cm, in x-ray films taken 2 years and 3 months ago (a period of 1 year and 10 months, Figs. 9 and 10). The x-ray films taken 5 months ago revealed a small irregular shaped shallow depressed area and small nodular mucosa with marginal abnormalities, 10 cm in length (Figs. 7, 8). These findings suggest that some esophageal carcinomas remain in the submucosa or intramucosa for a long period of time.