Long segment Barrett's esophagusを背景として生じた長径18 cmのBarrett食道癌の1例 [in Japanese] Barrett's Adenocarcinoma 18 cm in Length Arising from Long Segment Barrett's Esophagus [in Japanese]
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18 cmのlong segment Barrett's esophagus（以下，LSBEと略記）を背景に，その全域に発生したBarrett食道癌を経験した．症例は63歳の男性で，前医にて中部食道に潰瘍性病変を指摘され当科紹介となった．上部消化管内視鏡検査では切歯より24 cmから42 cmに至るLSBEを認め，29 cmの部位に3型病変を認めた．生検結果は腺癌（tub2）であり，精査を行いBarrett食道癌MtLt，type3，cT3，cN0，cM0，cStage IIと診断し手術を施行した．病理組織学的検査では長径18 cmに及ぶLSBEと，4 cmの3型病変（T2）に併存したLSBE全域に及ぶ粘膜内癌を認めた．本邦ではLSBEの報告はまれであるが，今後LSBEやBarrett食道癌の増加が懸念される．今回，LSBE全域が癌化したまれな症例を経験したので報告する．
A 63-year-old man who had been experiencing heartburn and was found to have Barrett's esophageal adenocarcinoma throughout an 18-cm region of long segment Barrett's esophagus (LSBE). Upper gastrointestinal endoscopy revealed LSBE, the proximal end being 24 cm from the teeth, and a type 3 tumor at 29–33 cm. Moderately differentiated adenocarcinoma Tub2 was diagnosed by histopathological examination of a biopsy specimen. CT and PET scans showed no distant or lymph node metastases, thus, the esophageal adenocarcinoma was classified as stage II (T3N0M0). The patient underwent transthoracic esophagectomy by the McKeown technique and gastric tube reconstruction. The postoperative histopathological diagnosis was muscularis propria invasion, and was staged as T2. The intramucosal carcinoma spread over the entire field of the 18-cm LSBE. There have been relatively few reports of Barrett's esophageal adenocarcinoma in LSBE in Japan. However, because the incidence of LSBE and Barrett's esophageal adenocarcinoma will likely increase with the westernization of Japanese lifestyle and diet, Japanese physicians should include Barrett's esophagus in their differential diagnoses when evaluating patients with esophageal symptoms. To the best of our knowledge, this is the first report of cancer permeating throughout an area of LSBE.
- The Japanese Journal of Gastroenterological Surgery
The Japanese Journal of Gastroenterological Surgery 49(3), 169-176, 2016
The Japanese Society of Gastroenterological Surgery