Yoshida K, Ide H, Murata Y, Kobayashi A, Hanyuu H, Yamada A
Nihon Kyobu Geka Gakkai Zasshi. 1989 Jul;37(7):1430-5.
The prognosis of mucosal carcinoma of the esophagus is extremely good because of low frequency of lymphatic invasion compared with submucosal carcinoma. A 64-year-old male was admitted presented with dysphagia and weight loss. Roentgenogram and esophagoscopy revealed erosive lesions in the lower portion of the esophagus and a huge submucosal tumor that looked like the myosarcoma in the cardial portion. After total resection of thoracic esophagus and partial gastrectomy, esophagogastrostomy was done through the anterior thoracic route. During the operation, we found a few disseminative foci in the thoracic cavity (pl1) and direct invasion of cardial tumor to the celiac portion. Therefore, the operation was absolute by palliative. Histological examination of the resected specimen showed that the IIc-like lesion of the lower portion of the esophagus was a moderately differentiated squamous cell carcinoma invading the mucosa (mm), which was 2.0 x 1.6 cm in size, with marked lymphatic invasion, and intra-mural metastatic foci (7.0 x 5.0 cm) at the cardial portion. The patient died 3 months after the operation with mediastinal lymph node metastasis. In our 19 cases of resected mucosal carcinoma of the esophagus, lymphatic invasion was positive in 16%, and lymph node metastasis was positive in 16%, and intramural metastasis was in only one case. Frequency of intramural metastasis in esophageal carcinoma is about 10% in sm -a3 lesion, 5% in mm. In our experience, the prognosis of curatively resected mucosal carcinoma of the esophagus is generally good. We get long survivals, when curative operation is undergone, even if the lymphatic invasion is positive.
与黏膜下癌相比，食管黏膜癌的淋巴浸润频率较低，因此其预后非常好。一名64岁男性因吞咽困难和体重减轻入院。X线检查和食管镜检查显示食管下段有糜烂性病变，以及一个位于贲门部、看似平滑肌肉瘤的巨大黏膜下肿瘤。在进行胸段食管全切除和部分胃切除术后，经前胸途径行食管胃吻合术。手术过程中，我们在胸腔内发现了一些播散性病灶（pl1），且贲门部肿瘤直接侵犯至腹腔部分。因此，该手术属于绝对姑息性手术。切除标本的组织学检查显示，食管下段类似IIc型的病变为中度分化的鳞状细胞癌，侵犯黏膜（mm），大小为2.0×1.6 cm，有明显的淋巴浸润，且在贲门部有壁内转移灶（7.0×5.0 cm）。患者术后3个月因纵隔淋巴结转移死亡。在我们19例切除的食管黏膜癌病例中，淋巴浸润阳性率为16%，淋巴结转移阳性率为16%，壁内转移仅1例。在sm -a3病变中，食管癌壁内转移的发生率约为10%，在mm病变中为5%。根据我们的经验，食管黏膜癌根治性切除后的预后总体良好。即使淋巴浸润阳性，进行根治性手术后也能获得较长生存期。
