Konishi M, Kato H, Tachimori Y, Watanabe H, Yamaguchi H, Ishikawa T, Itabashi M, Hirota T
Department of Surgery, National Cancer Center Hospital, Tokyo.
Jpn J Clin Oncol. 1992 Aug;22(4):292-6.
We report a case of adenocarcinoma in Barrett's esophagus following a total resection of the gastric remnant. A 52-year-old man had undergone a distal gastrectomy for gastric cancer at 33 years of age and a total resection of the gastric remnant for local recurrence of the gastric cancer at 35 years of age. Repeated endoscopic examinations revealed the sequence of reflux esophagitis and Barrett's esophagus. Furthermore, adenocarcinoma in Barrett's esophagus was detected in December, 1989. A subtotal esophagectomy was performed in January, 1990. The elevated lesion in the lower esophagus showed coarse lobulation and measured 7.4 x 3.2 cm. The histologic type was that of well-differentiated adenocarcinoma, with the invasion limited to the muscularis mucosae without lymph node involvement. Severe dysplasia was seen adjacent to the definite carcinoma. The case supports the acquired theory of pathogenesis for Barrett's esophagus and suggests that reflux esophagitis after total gastrectomy may result in a dysplasia-carcinoma sequence.
我们报告一例胃残余物全切除术后巴雷特食管腺癌病例。一名52岁男性在33岁时因胃癌接受了远端胃切除术，35岁时因胃癌局部复发接受了胃残余物全切除术。反复内镜检查发现了反流性食管炎和巴雷特食管的发展过程。此外，1989年12月检测到巴雷特食管腺癌。1990年1月进行了次全食管切除术。食管下段的隆起病变呈粗分叶状，大小为7.4×3.2厘米。组织学类型为高分化腺癌，浸润局限于黏膜肌层，无淋巴结受累。在明确的癌灶附近可见重度发育异常。该病例支持巴雷特食管发病机制的后天学说，并提示全胃切除术后的反流性食管炎可能导致发育异常-癌序列。
