外科からみた消化器の悪性腫瘍と皮膚病変

Gastrointestinal Malignancy with Skin Diseases Viewed from the Surgical Standpoint

　消化器疾患の中には皮膚に特定の病変をもって現れてくるものがあり，逆に，皮膚疾患の中には特有の消化器病変を有するものがある．更に，系統疾患の部分病変として，消化器および皮膚に病変を来すものなど，体表皮膚の病変は隠された消化器疾患を診断するうえで重要な症状として，その意義は大きい．しかし，消化器疾患と皮膚疾患との因果関係および病因については不明の点が多い．消化器病変と皮膚疾患が併存する症例の頻度は余り高くはないが，皮膚病変はかなり特徴的な所見を有することから，消化器の重要な疾患を早期に発見しうる有力な手掛かりとなりうる．本稿では消化器悪性腫瘍と皮膚病変が併存した症例について，その臨床像，治療成績，予後などについて外科的に検討した成績を述べる．

　We have encountered 13 patients with gastrointestinal malignancy and coexisting skin diseases such as acanthosis nigricans, dermatomyositis, erythrodermia, pemphigoid, ichthyosis vulgaris and Recklinghausen's disease. There were nine cases (69％) with gastric cancer. Although the skin lesions appeared before the onset of gastrointestinal symptoms in almost all cases, 10 (77％) were of advanced cancer. In the acanthosis nigricans cases, involvement of esophageal mucosa was not uncommon in autopsy cases, however, a few has been reported on the clinical observation of such lesions. In the present communication, we report a 70 year-old woman with acanthosis nigricans, esophageal papilloma and gastric cancer in whom the improvement of esophageal involvement was observed by the surgical resection of gastric cancer.