食道内分泌細胞癌の1例

Esophageal Endocrine Cell Carcinoma, Report of a Case

要旨　患者は67歳，女性．主訴は嚥下時不快感．上部消化管内視鏡検査で，上切歯列より25cmの中部食道右壁に病変を指摘された．X線検査では，周囲に立ち上がりの明らかな辺縁隆起を伴う不整形の陥凹性病変が描出された．その肛門側には扁平な隆起形態の副病変を伴っていた．内視鏡的には粘膜下腫瘍様の立ち上がりを呈し，頂部に潰瘍を有する病変であり，隆起部分は潰瘍辺縁までヨード染色された．この病変は約10日間のうちに，内腔に突出した隆起の丈が低く形態変化したことが確認された．主病巣は，切除標本で，0-III型，3.0×2.8cm大で，粘膜下腫瘍様発育形態を示した．組織学的にはsm3腫瘍で，大型細胞の充実胞巣が主体を占め，一部で小細胞型の充実胞巣が混在し，腫瘍細胞は特殊染色で内分泌細胞の性質が陽性を示すことから，内分泌細胞癌と診断された．副病変は深達度epの，高分化型扁平上皮癌であった．術後多発肝転移，肋骨転移が出現，手術から14か月後に死亡した．

　A 67-year-old female was admitted to our hospital with complaints of dysphagia. X-ray examination showed, in the middle esophagus, an irregular ulcerative lesion with a clear margin surrounded by tumorous elevation. Endoscopically the ulcerative lesion was unstained by iodine staining but its surface was stained. Under the biopsy diagnosis of adenocarcinoma, an operation was performed. Histopathological examination of the tumor, measuring 3.0×2.8 cm, showed the tumor to be solidly growing under the epithelium and invading to the deep layer of the submucosa. Immunohistochemically, tumor cells were positive for chromogranin A, Grimelius,CD56 and NSE. The lesion was finally diagnosed as endocrine cell carcinoma. Postoperatively, the patient developed multiple metastases in many organs and died after 14 months.

　1) Department of Surgery, Fukui Prefectural Hospital, Fukui, Japan

　2) Department of Pathology, Fukui Prefectural Hospital, Fukui, Japan