逆流性食道炎に併存した食道表在癌の1例 [in Japanese] A CASE OF ESOPHAGEAL SQUAMOUS CELL CARCINOMA ASSOCIATED WITH REFLUX ESOPHAGITIS [in Japanese]
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逆流性食道炎に併存した食道表在癌の1例を経験した.症例は67歳の男性で,中咽頭癌の診断で当院耳鼻科にて外科的治療を受けた.術後2カ月目に貧血の精査目的で上部消化管内視鏡検査を行ったところ,食道胃接合部直上に逆流性食道炎が見られた.生検の一部に癌が疑われ再検を要したが,その後誤嚥による遷延性肺炎を起こしたため経過観察できていなかった. 2年4カ月経過後に施行した内視鏡検査では,食道胃接合部直上に径20mm大のO-IIc型表在癌が認められた.外科的に切除し検索したところ,深達度m3の中分化型扁平上皮癌であった.おそらく逆流性食道炎に併存して診断困難であった小癌病変が, 2年4カ月経過後に明らかになったものと考えられた.本症例のような頭頸部癌担癌患者等の食道癌high risk群の場合,逆流性食道炎の治療を行うとともに,厳重な食道癌合併の検索が必要であると思われた.
We reported a case of superficial esophageal squamous cell carcinoma associated with reflux esophagitis in a 67-year-old man. He had been surgically treated for an oropharyngeal cancer by an otorhinopharyngolarynglologist in our hospital. After two months, we detected reflux esophagitis near the esophago-gastric junction (EC junction) by upper digestive tract endoscopy. One of the biopsy sections of the lesion was suspected of malignancy. But he had not been followed up for a long time because he had been constantly suffered from aspiration pneumonia. Twenty-eight months later, endoscopy revealed a 0-IIc type-superficial cancer 20mm in diameter near the EC junction instead of esophagitis. We performed an esophagectomy and examined the resected specimen. The lesion was diagnosed as moderately differentiated squamous cell carcinoma which infiltrated into the mucosal muscularia. In this case, a small malignant lesion which had been concealed by reflux esophagitis, grew a detectable cancer lesion for 28 months. It is suggested that in a high risk group of esophageal cancer, including patients with head and neck cancer, treatment for reflux esophagitis as well as strict examination are necessary to detect a probable occurrence of cancer lesion in the esophagus.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 57(7), 1612-1616, 1996-07-25
Japan Surgical Association