Yamanouchi Satoshi, Sako Yukiko, Suemitsu Shinsuke, Tsukano Kousuke, Kotani Satoshi, Kusunoki Ryusaku, Miyaoka Youichi, Miyake Tatsuya, Fujishiro Hirofumi, Kohge Naruaki, Yamamoto Tomohiko, Ohnuma Hideyuki
Department of Gastroenterology, Shimane Prefectural Central Hospital, 4-1-1 Himebara, Izumo, Shimane, 693-8555, Japan.
Department of Internal Medicine, Oki Hospital, Okinoshima-cho, Oki-gun, Shimane, Japan.
Clin J Gastroenterol. 2018 Feb;11(1):29-33. doi: 10.1007/s12328-017-0792-6. Epub 2017 Oct 27.
The patient was a 57-year-old man who had undergone endoscopic submucosal dissection for early esophageal cancer (distance from incisor tooth, 30 cm) when he was 50 years of age. Pathological findings showed squamous cell carcinoma invading the lamina muscularis mucosae and mild lymphatic invasion. Considering the possibility of lymph node metastasis and distant metastasis, we administered radiation chemotherapy (CDDP+ 5-FU, total radiation 41.4 Gy) in the same year. Two years later, follow-up endoscopy revealed a white, flat, elevated lesion in the thoracic esophagus (distance from incisor tooth, 36 cm) that was not stained by Lugol's iodine. A biopsy of this lesion was performed. Although esophageal epidermization was seen, there were no findings suggestive of malignancy. The lesion grew slightly during four and a half years of follow-up after identification. We performed a repeat biopsy of the lesion, and the tissue was diagnosed as atypical epithelium, so we performed endoscopic mucosal resection for diagnostic and therapeutic purposes. The postoperative pathological diagnosis was squamous cell carcinoma of T1a-LPM with epidermization due to its histological features. To the best of our knowledge, this is the first report of esophageal cancer accompanied by epidermization.
该患者为一名57岁男性，50岁时因早期食管癌（距门齿30 cm）接受了内镜下黏膜下剥离术。病理检查结果显示为鳞状细胞癌，侵犯黏膜肌层且有轻度淋巴浸润。考虑到有淋巴结转移和远处转移的可能性，同年我们对其进行了放化疗（顺铂 + 5-氟尿嘧啶，总放疗剂量41.4 Gy）。两年后，随访内镜检查发现胸段食管（距门齿36 cm）有一个白色、扁平、隆起的病变，卢戈氏碘染色不着色。对该病变进行了活检。虽然可见食管上皮化生，但未发现提示恶性肿瘤的迹象。在发现病变后的四年半随访期间，病变略有增大。我们对该病变再次进行了活检，组织被诊断为非典型上皮，因此我们进行了内镜黏膜切除术以明确诊断并进行治疗。术后病理诊断为T1a-LPM期鳞状细胞癌，因其组织学特征伴有上皮化生。据我们所知, 这是首例伴有上皮化生的食管癌报告。
