下部食道・噴門切除後の円柱上皮化食道に発生した腺扁平上皮癌の1治験例

Adenosquamous Carcinoma Arising from the Esophagus Lined by Columnar Epithelium after the Esophagocardiectomy, Report of a Case

要旨　患者は28歳の男性．嚥下困難を主訴に来院した．既往歴として4歳時に，軟骨迷入を伴う噴門狭窄で下部食道・噴門切除術が施行されている．更に，12歳時に吻合部口側に全周性の食道潰瘍を指摘されていた．X線検査で気管分岐部より下方に螺旋型の陰影欠損を認め，内視鏡検査では，上門歯列より24cmで明らかな粘膜移行部を認め，36cmに腫瘍を認めた．生検で低分化型腺癌が証明され，右開胸開腹胸部食道亜全摘胸壁前頸部食道回盲部吻合術を施行した，切除標本により，円柱上皮化食道に発生した腺扁平上皮癌と診断され，組織学的進行度は，a₂n₂ly（＋）v（＋）のstage Ⅲであった．

　The patient was 28 years old and his chief complaint was dysphagia. He had a past history of lower esophagocardiectomy due to cardiastenosis associated with cartilae aberration at the age of four. It had further been pointed out that he had esophageal ulceration on the entire circumference at the oral side of the anastomosis at the age of 12.

　In double contrast pictures of the esophagus a spiral shaped defect appears at a site below the point of bifurcation of the trachea. Endoscopic examination revealed a mucosal change beginning at a distance of 24 cm from the incisors. At a point 36 cm from the incisors a tumor was discovered.

　Biopsy specimen revealed poorly-differentiated adenocarcinoma. Antethoracic esophagoileostomy through the right thoracic approach was performed.

　From the incised specimen, it was diagnosed that adenosquamous carcinoma had developed at the esophagus which was lined by columnar epithelium. It was stage III of a₂n₂ly (+) v (+).