食道癌・肺癌・小腸GISTを合併した同時性三重複悪性腫瘍の1例

Synchronous Triple Malignant Tumors in the Esophagus,Lung and Small Intestine, Report of a Case

　症例は65歳，女性．貧血の精査目的にて入院．上部消化管内視鏡検査にて，切歯から30cmの左側後壁に白斑を認め，同部はヨード不染を呈し，0-IIa病変を認めた．EMRが施行され，病理組織学検査では深達度m1の扁平上皮癌であった．また，小腸造影検査にて回腸に約5cmの管外に発育した中心潰瘍を伴う粘膜下腫瘍を認め，手術が施行された．病理組織学検査，免疫組織化学的検査にて，gastrointestinal stromal tumor(GIST), combined smooth muscle-neural type, malignantと診断した．なお，術前の胸部CT検査にて，左肺S4に18mmの腫瘤陰影を認めた．肺癌が疑われ，後日手術が施行された．病理組織学検査にて，高分化乳頭腺癌と診断された．食道癌，肺癌，小腸GISTの同時性三重複悪性腫瘍の報告はなく，まれな症例と考えられた．

　The patient, a 65-year-old woman, suffered from an anemic condition and was admitted for detailed examinations. Upper gastrointestinal endoscopy revealed the presence of white blotches at the left posterior wall 30 cm from the incisor. The area resisted staining with iodine, showing an 0-IIa lesion. EMR was conducted. A histopathological examination revealed a squamous cell carcinoma with a depth of m1. A radiographic examination of the small intestine detected a submucosal tumor accompanied by a central ulcer that had developed about 5 cm extra-tubally in the ileum. The lesion was treated surgically. A diagnosis of gastrointestinal stromal tumor (GIST), combined with a smooth muscle-neural type with malignancy was made, based on the histopathological and immunohistochemical observations. A tumor image, measuring 18 mm at S 4 in the left lung field, was also detected from a presurgical thoracic CT. Lung cancer was suspected and the patient later underwent surgery. A histopathological examination led to a diagnosis of a highly differentiated papillary adenocarcinoma. There have been no reports of simultaneous development of three malignant tumors (esophageal and lung cancers and GIST of the small intestine). The present case represents a very rare incidence.