極めてまれな巨大ポリープ様食道脂肪肉腫の1例

Huge Polypoid Esophageal Liposarcoma, Report of An Extremely Rare Case

要旨　症例は71歳，男性．粘膜下腫瘍として近医にて経過観察されていた．嚥下障害が出現し当院受診した．食道入口部に基部を持つ巨大食道粘膜下腫瘍の診断にて全身麻酔下にジャンボスネアを肛門側よりかけて内視鏡的切除術を施行した．茎部は比較的細かったため切除は容易であったが，経口的に摘出が困難であり，一部を回収し切除術を終了した．病理組織検査では，異型脂肪芽細胞がみられ分化型脂肪肉腫の診断であった．免疫染色では，異型脂肪芽細胞でS-100蛋白陽性であった．極めてまれな食道脂肪肉腫の1例を経験したので報告した．局所再発率は高いと言われており，今後厳重な経過観察が必要と考えられた．

　A 71-year-old male patient was followed up by a neighboring physician as having submucosal tumor. The patient developed dysphagia and visited our clinic, where he was diagnosed as having a huge esophageal submucosal tumor with its base at the beginning of the esophagus. Endoscopic resection was performed under general anesthesia using a jumbo snare inserted from the anal side. As the pedicle part was relatively narrow, it was easy to excise, but it was difficult to extract it orally. Therefore, a part of it was recovered and the excision was terminated. Histopathological examination revealed atypical lipoblasts and the patient was diagnosed with differentiated liposarcoma. Immunostaining showed atypical lipoblasts and S-100 protein positive. We encountered this extremely rare esophageal liposarcoma case and reported it here. The local recurrence rate was said to be high, so strict follow-up has been necessary thereafter.

　1) Department of Internal Medicine, Cancer Institute Hospital, Tokyo

　2) Department of Pathology, Cancer Institute, Tokyo