Barrett食道に発生した早期癌の1例

Early Carcinoma Existing in Barrett's Esophagus, Report of a Case

　いわゆるBarrett食道は1950年Barrettにより報告され，彼により後に“The lower esopha-gus lined by columnar epithelium”という概念が提唱された．Poleynardらによれば1977年までにBarrett食道に発生した腺癌の報告は50例であり，その後の報告を含めても70例に満たない．本邦では中村らの報告を嚆矢とし，2例と数少ない．今回われわれは小体症を伴う，Barrett食道に発生した早期癌を経験したので，若干の文献的考察を加えて報告する．

　A 46-year-old man was admitted to Keio University Hospital with a three-month history of retrosternal burning sensation. The patient had dwarfism with remarkable scoliosis, which was osteogenesis imperfecta tarda. The patient attributed to 122.5 cm in height and weighed 35 kg. Laboratory findings on admission showed no abnormality. Radiologic and endoscopic findings showed irregular mucosal elevations at the middle esophagus with hiatal hernia. Biopsy specimens disclosed columnar epithelium and adenocarcinoma.

　The patient underwent intrathoracic esophageal resection and cervical esophagogastrostomy. Any malformation or abnormality in the alimentary tract was detected at the operation. The elevated lesion in the resected specimen measured 33×29 mm in size and was located in the anterior wall of the middle esophagus.

　Histologically the lesion demonstrated poorly differentiated adenocarcinoma, partially signet-ring cell carcinoma, existing in the columnar-lined epithelium, the invasion being limited to the submucosal layer. There was no evidence of lymph node metastasis. The case is believably the first report of a successfully resected early carcinoma located in Barrett's esophagus in Japan.