食道アカラシアに合併した食道癌の1切除例

Squamous Cell Carcinoma Associated with Achalasia of the Esophagus, Report of a Case

要旨　患者は47歳，男性．6年前より食事時のつかえ感あり．このとき，近医の胃X線検査で食道拡張を指摘された．1991年の人間ドックで食道の異常を認め，当科へ紹介となった．食道X線検査では，著明な拡張とS字状の蛇行および不規則な収縮波を認めた．また，ⅠmからEiにかけて，表面がわずかに凹凸した3.3cm大の亜有茎性隆起性病変とその周囲のバリウム付着異常部を認めた．食道内視鏡検査では，切歯列より約26cmから38cmの12時～7時に発赤調の0-Ⅰ＋Ⅱa＋Ⅱc型病変を認め，ヨードに不染であった．以上より，食道アカラシアとこれに合併した食道癌と診断した．超音波内視鏡検査では，食道全域の拡張と壁の肥厚が認められ，0-1型腫瘍部での深達度はmpと診断した．病理組織学的には拡張した食道全域にわたり神経節細胞の減少と神経線維の変性，内輪筋を主とした食道壁の肥厚が認められ，アカラシアと診断された．また，これに合併した中分化型扁平上皮癌は，深達度mp，1y（＋），v（－），n：1/76であった．

　A 47-year-old male had complained dysphagia for the six years preceding admission. Barium swallow at another hospital revealed esophageal dilatation, but no further examination was carried out. In 1991, upper gastrointestinal barium examination showed elevated lesion of the esophagus, and he was admitted to our hospital. Esophagogram (Fig. 1) revealed a markedly dilated sigmoid-shaped esophagus with persistent barium retention of the esophageal vestibule. A double contrast view demonstrated a polypoid lesion in the midthoracic esophagus with nearby irregular mucosa. Esophagoscopic examination (Fig. 2) showed a polypoid lesion with an irregular surface surrounded by reddish and slightly elevated lesions with coarse granular surface. Iodine staining showed the lesion to be unstained, and compatible with this lesion as esophageal carcinoma associated with achalasia. Endoscopic ultrasonographic picture (Fig. 3) showed symmetrical thickening of the whole esophageal wall and the tumor invading into the proper muscle layer at 35 cm from the incisor teeth. Histological examination (Figs. 4 and 5) showed a moderately differentiated squamous cell carcinoma with achalasia of the esophagus. There were degeneration and marked loss of ganglion cells in Auerbach's plexus. The tumors was approximately 72×69 mm in size and invaded into proper muscle layer.