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Stomach and Intestine(Tokyo) Volume 42, Issue 10 （September 2007）

胃と腸 42巻10号（2007年9月発行）

Japanese English

早期胃癌研究会症例

Barrett食道に発生した非小細胞型vimentin陽性未分化癌の1例 Vimentin-positive Esophageal Undifferentiated Carcinoma of the Non-small-cell Type Arising in Barrett's Esophagus, Report of a Case 村田篤彦 ¹ , 赤星和也 ¹ , 神代由美子 ² , 八尾隆史 ² , 木村光秀 ¹ , 松井謙明 ¹ , 本村廉明 ¹ , 久保川賢 ¹ , 大内二郎 ¹ , 本田邦臣 ¹ , 遠藤伸悟 ¹ , 渡邊雅之 ³ , 大屋正文 ⁴ , 中村和彦 ⁵ , 西原秀一郎 ⁶ Atsuhiko Murata ¹ , Kazuya Akahoshi ¹ , Yumiko Kumashiro ² , Takashi Yao ² , Mitsuhide Kimura ¹ , Noriaki Matsui ¹ , Yasuaki Motomura ¹ , Masaru Kubokawa ¹ , Jiro Ouchi ¹ , Kuniomi Honda ¹ , Shingo Endo ¹ , Masayuki Watanabe ³ , Masahumi Oya ⁴ , Kazuhiko Nakamura ⁵ , Syuichiro Nishihara ⁶ ¹麻生飯塚病院消化器内科 ²九州大学大学院医学研究院形態機能病理学 ³麻生飯塚病院外科 ⁴麻生飯塚病院病理部 ⁵九州大学大学院医学研究院病態制御内科学 ⁶西原内科消化器科クリニック ¹Department of Gastroenterology, Aso Iizuka Hospital, Iizuka, Japan ²Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyusyu University, Fukuoka, Japan ³Department of Surgery, Aso Iizuka Hospital, Iizuka, Japan ⁴Department of Pathology, Aso Iizuka Hospital, Iizuka, Japan ⁵Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan ⁶Nishihara Internal Medicine and Gastroenterological Clinic, Iizuka, Japan キーワード：非小細胞型未分化癌 , vimentin , Barrett食道 Keyword: 非小細胞型未分化癌 , vimentin , Barrett食道 pp.1543-1549

発行日 2007年9月25日 Published Date 2007/9/25

DOI https://doi.org/10.11477/mf.1403101202

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要旨　患者は65歳，男性．貧血および嚥下困難のため，近医にて上部消化管内視鏡検査を施行し，下部食道に腫瘍を指摘され当院紹介となった．食道X線検査および内視鏡検査では，下部食道に表面平滑な周辺隆起を伴う不整な潰瘍性病変を認めた．また腫瘍周囲の背景粘膜にはBarrett食道を認めた．生検結果は未分化癌で，EUSを含めた諸検査により深達度Ad，進行度stage IIIと術前診断し，外科的切除を行った．術後病理組織学的検索では非小細胞型未分化癌，vimentin(＋)，腫瘍径57×29mm，深達度mp，ly3，v1，infα，n4，stage IVaと診断された．術後補助化学療法を施行したが手術の10か月後に死亡した．

　A 65-year-old man with anemia and dysphagia was referred to our hospital with a diagnosis of esophageal tumor of the lower esophagus.

　X-ray examination revealed an ulcerative lesion with coarse nodules in the surface, approximately 6 cm in length in the lower esophagus. Esophagogastroduodenoscopy showed an irregular ulcerative lesion with a smooth-surfaced small peripheral upheaval, and the tumor was surrounded by smooth-surfaced erythematous mucosa. The biopsy specimen taken from the tumor was diagnosed as undifferentiated carcinoma, and that from the erythematous mucosa revealed Barrett's epithelium, respectively. EUS revealed a hypoechonic mass expanding into the adventitia (Ad) with lymph node involvement (N2). Preoperative CT examination revealed no distant metastasis. The lesion was preoperatively diagnosed as stage III undifferentiated carcinoma arising in Barrett's esophagus, and the patient underwent surgical resection.

　Histologically, the tumor was positive for vimentin and diagnosed as a primary esophageal undifferentiated carcinoma of the non-small-cell type arising in Barrett's esophagus. The tumor size was 57×29 mm, pT2 (mp), ly3, v1, infα, n4. After surgical resection, he was treated with chemotherapy using S-1 (100mg/day). However, he died due to aspiration pneumonia 10 months later. This is a very rare case of vimentin-positive esophageal undifferentiated carcinoma of the non-small-cell type arising in Barrett's esophagus.