A CASE OF DOUBLE LESIONS OF ADENOSQUAMOUS CARCINOMA AND ADTENOCARCINOMA ARISING FROM BARRETT'S ESOPHAGUS

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A 42-yrer-old male with a chief complaint of dysphagia visited our hospital. Esophagoscopy showed the lower half of the esophagus to be replaced with reddish mucosa, where two lesions, a raised, partly ulcerated mass, 7.5 × 5.5 cm, at the middle of the esophagus, and a granular, depressed lesion (IIc), 1.5 × 0.7 cm, in the lower part of the esophagus were found. Biopsy revealed squamous cell carcinoma in the raised mass, signet ring cell carcinoma in the IIc lesion, and columnar epithelium in a reddish mucosa. Esophagogastrectomy was performed. Histological examination showed the reddish mucosa to be composed of Barrett's esophagus with mild to severe dysplasia. The proximal lesion was composed of well differentiated adenocarcinoma and adenos-quamous cell carcinoma invading the adventitia (al). The IIc lesion showed partly poorly differentiated and partly well differentiated adenocarcinoma invading the submucosa. In Barrett's esophagus, various degrees of dysplasia of the columnar epithelium are often found and this fact is suggestive of consequent carcinomatous transformation. For this reason, it is mandatory to keep patients with Barrett's esophagus under strict follow-up with endoscopic biopsy. Surgical treatment should be undertaken only when carcinomatous change becomes evident, because dysplastic changes are known to persist for years in some cases.
社団法人日本消化器内視鏡学会の論文