食道粘膜のびまん性乳頭状増殖を認めた悪性黒色表皮腫の1例

A Malignant Acanthosis Nigricans Associated with an Esophageal Papillomatosis and Gastric Carcinoma, Report of a Case

　黒色表皮腫（acanthosis nigricans）は皮膚の角化増生，色素沈着，乳頭状増殖をtriasとし，その半数が悪性型で内臓の悪性腫瘍，特に胃癌との合併がよく知られている．本症は皮膚病変のほかに口唇，口腔粘膜，食道，腟などにも特異な増殖性変化を伴うことが知られている．われわれも口腔ならびに食道粘膜に著明な乳頭状増殖性変化を認めた1例を経験したので報告する．

　A 67 year-old man, whose stomach was partially removed eight years before because of ulcer, underwent laparotomy on Jan. 18, 1975, under a diagnosis of cancer of the gastric remnant (Borrmann type 4). However, resection was impossible on account of advanced cancer infiltration. Only intestinal fistula was made. In the course of follow-up with chemotherapy x-ray and endoscopy examinations of the lower esophagus showed cancer infiltration and granular changes of the mucosa. In February 1976 were seen papillomatous proliferation and swelling of the lips, buccal mucosa and the tongue. At our Department of Dermatology these changes were considered to be due to malignant acanthosis nigricans. Changes of the skin were confined to slight keratinization on the back of the hands and veruccous papullae on the back of hands and feet. The patient died of cancer cachexia and uremia on June 13, 1976. Biopsy revealed velvety changes in the whole length of the esophagus. Histologically, papillomatous proliferation was seen extensively over the epithelia of the esophageal mucosa. The diagnosis was epithelioma.

　It is well known that malignant acanthosis nigricans is accompanied with mucosal changes such as specific hyperplastic changes of the lips, tongue, esophagus or vulva, but reports have been rare regarding changes of the esophagus. To our knowledge, only eleven reports have been made so far both in Japan and abroad. The age and sex of the patients in most of reported cases was males in their sixties and seventies. Accompanying malignant diseases were gastric cancer in eight cases, esophageal cancer in one, multiple cancer of the esophagus and stomach in one and cancer of the kidney and renal pelvis in one. Most of the cases were accompanied with moderate to high degree of changes on the lips or buccal mucosa. In some cases changes of the lips or the buccal mucosa were not recognized when changes of the esophagus were not so manifest. In our experienced case granular changes on the esophageal mucosa had been recognized two or three months before the changes of the buccal mucosa became obvious.