胃スキルスを合併したAcanthosis Nigricansの著明な食道病変―1剖検例

Esophageal Involvement in Acanthosis Nigricans with Scirrhous Carcinoma of the Stomach, An Autopsy Case

　黒色表皮腫Acanthosis Nigricansは臨床的に皮膚の角化充進，乳頭状増殖，色素沈着を特徴とする疾患で，その悪性型Malignant Acanthosis Nigricansは内臓の悪性腫瘍，特に胃癌を高頻度に合併するため注目されている．皮膚病変の他，口腔や食道粘膜などの消化器病変をも伴うことが知られているが，X線や内視鏡による食道病変を観察された報告例は極めて少なく本邦では坂井ら⁸⁾⁹⁾の2例のみである．胃スキルスに合併した黒色表皮腫で，著明な食道病変をX線と内視鏡で観察出来た1例を剖検する機会を得たので報告する．

　A 62 year-old-male visited our clinic complaining of papillomatous Changes of lips and tongue. Radiological examinations revealed numerous granular shadows throughout the esophagus. Endoscopically, esophageal mucosa showed finely granular elevations in variation of shapes and sizes. By radiological and Endoscopical examinations, gastric advanced cancer (Borr. 4) was discovered. The patient died of peritoneal and pleural carcinosis three months later despite anticancer chemotherapy.

　Autopsy findings:

　The skin lesions with verrucous protrusions were typical acanthosis nigricans. The esophageal mucous membrane revealed densely fine granules and nodules along the entire length of esophagus, yellowish white in colour.

　Histologically, esophageal mucosa showed papillomatous arrangement with deep papilla. The lips, tongue, oral and pharyngeal mucosa also showed papillomatous changes. The gastric cancer (poorly differentiated adenocarcinoma) has exhibited metastasis in the lungs, kidney, pancreas, adrenals, retroperitoneum, pleura, peritoneum and surrounding lymph nodes.

　Only two cases with radiological and endoscopical features of acanthosis nigricans with esophageal involvement have been reported in Japan.