半年間に著明な形態変化を示した下咽頭癌の1例

Hypopharyngeal Cancer which Showed Rapid Growth in Six Months, Report of a Case

要旨　症例は70歳代，男性．食道表在癌内視鏡治療の既往があり，食道にまだら状不染帯を認めた．食道癌・咽喉頭癌の高リスク症例と考えられたため，半年ごとのサーベイランス内視鏡検査を行っていた．同検査にて，右梨状陥凹に隆起性病変を認め，表面は周囲と同様の粘膜で覆われていることから，SMTと診断した．6か月後の内視鏡にて右披裂喉頭蓋ひだから梨状陥凹にかけて，白苔を伴う不整な隆起性の下咽頭扁平上皮癌が出現した．本人の希望により放射線治療を行いCRを得た．本症例は6か月間で急速に発育したが，根治可能であった．したがって高リスク症例では少なくとも半年ごとに咽喉頭部の詳細な内視鏡検査を要すと思われた．

　A seventy-year old man underwent EMR for squamous cell carcinoma of the mid-esophagus. Because of numerous lugol unstained areas throughout his esophagus, he was considered to have an increased risk of metachronous cancer in the esophagus as well as in the head and neck. For these reasons, we maintained him on a semi-annual surveillance program.

　A small elevated lesion covered with normal epithelium was seen at the right pyriform sinus. It was thought to be a SMT, and was followed up six months later. A reddish elevated lesion with white coat was seen extended from the right aryepiglottic fold to the right pyriform sinus. This was biopsied and diagnosed as a moderately differentiated squamous cell carcinoma.

　The patient selected radiation therapy and complete response was achieved.

　Despite its rapid growth, the cancer of the hypopharynx was detected while still in a curable state. Semi-annual surveillance should be maintained in such a high risk case.