下咽頭癌に同時性に重複した食道微小癌の2例

Minute Carcinoma of the Esophagus with Synchronous Primary Carcinoma of the Hypopharynx, Report of Two Cases

要旨　〔症例1〕62歳，男性．咽頭痛を主訴に来院し下咽頭癌と診断され入院した．食道透視，内視鏡検査では病変を指摘できなかったが，内視鏡ルゴール法によりImに小不染域を認めた．切除食道の病理組織検査により2個の粘膜内微小癌病巣を確認した．〔症例2〕69歳，男性．右頸部腫瘤を主訴に来院し，下咽頭癌と診断され入院した．術前透視，内視鏡検査では食道に病変を認めず，下咽頭と共に抜去された食道のルゴール染色を併用した肉眼的検査でも異常はなかったが，組織検査により2個の上皮内微小癌病巣を認めた．2症例とも下咽頭および食道の病巣は扁平上皮癌であったが，食道病巣に脈管侵襲を認めなかったため重複癌と考えた．

　Two cases of minute carcinoma of the esophagus with synchronous primary carcinoma of the hypopharynx are presented. The subjects were men over 60 years of age, and each had a long-standing history of considerable cigarette and alcohol use. In both patients, lesions of the hypopharynx were found clinically prior to esophageal lesions. Despite the fact that they had no symptoms of swallowing disorder, esophageal investigations were performed. Esophagoscopy with Lugol's solution spraying method was able to demonstrate an esophageal lesion in one patient. The other patient could not be diagnosed clinically as having esophageal cancer. Histological examination confirmed the presence of squamous cell carcinomas of the esophagus in both cases. Two intramucosal tumors smaller than 3 mm were found in the first case, and two intraepithelial tumors smaller than 2 mm were found in the second case. These lesions were associated with dysplasia. Since there was no vascular invasion, they were considered as separate primaries rather than as case of metastasis.