早期食道癌の1例

A CASE OF EARLY CANCER OF THE ESOPHAGUS

Ⅰ．はじめに

　現在消化器癌の治療成績を向上させるためには，早期発見および早期治療が最良の方法であることはもちろんである．胃癌においては診断技術の進歩によって多数の早期例が発見され治療されているが，食道癌では臓器の形態や機能上から早期発見は難しく，わが国においてもいまだ数例の報告を見るに過ぎない．最近われわれは極めて小さい早期食道癌の1例に遭遇し，これを切除し得たのでここに報告する．

　A very small early esophageal cancer was recently encountered which was correctly diagnosed and resected with success. Unlike early cancer of the stomach, that of the esophagus is so difficult in its early detection that its reports published to date are only a few in number in this country.

　Case: 58-year-old female.

　Chief complaint: postprandial right-side chest pain.

　Present history: She had been suffering from the above since April 1967. She was found to have an abnormal finding in her esophagus in November of the same year when she was examined by esophagoscopy. The same examination later done at National Cancer hospital revealed a protruded lesion, 33cm away from the incisors, on the left-side posterior wall of the esophagus. The lesion was later confirmed by biopsy as of squamous cell carcinoma. X-ray study both in the first oblique and the frontal view visualized it as having a seemingly protruded surface. on Feb. 23 1968, right-side thoracotomy with total excision of the thoracic esophagus was performed followed by transretrosternal esophago-gastric anastomosis.

　In the resected specimen was seen a yellowish white protrusion of irregular shape measuring 0.8 by 0.5cm, located on the posterior wall a little to the left, 5cm oral from the esophago-gastric junction. Histologically it was squamous cell carcinoma limited within the submucosa. The lesion, measuring also 0.8 by 0.5cm, was almost of the same extent as the protrusion macroscopi cally observed. Regional lymph nodes, including secondary ones, were completely resected. No metastasis was found in any of them.

　This case belongs to what Prof.Nakayama defined as early cancer of the esophagus, with its size being the smallest of all reported to date.

　The role of x-ray examination in the diagnosis of early esophageal cancer is lastly commented on with some discussions on its definition.