食道原発性腺様囊胞癌の3例

Primary Adenoid Cystic Carcinoma of the Esophagus, Report of Three Cases

　原発性食道癌の大部分は扁平上皮癌であり，腺様囊胞癌は非常にまれとされている．

　最近，われわれは小さい隆起性食道癌で腺様囊癌と診断された症例を経験したので，当センターで，これ以前に経験した2例を含め，若干の文献的考察を加えて報告する．

　In this paper three cases of esophageal adenoid cystic carcinoma, an infrequent malignancy of the esophagus, are reported, and 24 reported cases are collected and analysed.

　〔Case1〕 A 71-year-old woman showed a tumor (1.6×1.3×0.3 cm) at middle third of the esophagus at an upper gastrointestinal endoscopy for her gastric ulcer (Fig. 1～3). Histologic studies revealed that the tumor was covered by the esophageal mucosa and adenoid cystic carcinoma existed between covering epithelium and submucosal layer (Fig. 4～7). There was no lymph node metastasis, but slight lymphatic vascular invasion and moderate venous vascular invasion was seen. She is healthy eight months after the operation.

　〔Case2〕 A 66-year-old man had a tumor (3.8×2.0×0.5 cm) at lower third of the esophagus (Fig. 9). Histologic studies of resected specimen showed adenoid cystic carcinoma with submucosal invasion, slight lymphatic vascular invasion and moderate venous vascular invasion (Fig. 10). There was no lymphatic node metastasis. He died of liver and lung metastasis 14 months after the operation.

　〔Case3〕 A 63-year-old man had a tumor (4.5×4.0×0.8 cm) at middle third of the esophagus (Fig. 11). The tumor showed marked elevation and central ulceration (Fig. 12). It showed moderate invasion to the adventitia of the esophagus and lymph node metastasis of paracardial region (Fig. 13, 14). He died of lung metastasis 15 months after the operation.

　Twenty-seven cases of esophageal adenoid cystic carcinoma were analysed: 16 men and 10 women (mean age, 61.3)were examined. Two cases occurred in the upper third of the esophagus, 13 occurred in the middle third, and 12 occurred in the lower third. According to gross classification, 10 cases were ulcerative, 12 were protruded, and 5 were not classified. Most of them died within two years after the operation, except one case who lived more than five years.

　Recurrance occurred on lung, liver, cranium, cerebral hemispheres, kidney, and peritoneum due to hematogenous metastasis. Prognosis of esophageal adenoid cystic carcinoma should be suspected as poor. Our〔Case1〕stands next to the smallest tumor ever reported. Although it showed no lymph node matastasis, its poor prognosis was suspected because of its marked venous vascular invasion.