食道平滑筋肉腫の1治験例

LEIOMYOSARCOMA OF THE ESOPHAGUS; A CASE REPORT

Ⅰ．はじめに

　食道に原発する悪性腫瘍のうち，肉腫はごく稀な疾患とされている．文献上でも0.1％から2.2％といわれ（第1表），本邦文献上でも31例を数えるにすぎない．当消化器病センターで，昭和40年2月から43年6月までに切除した350例の食道噴門部悪性腫瘍のうちでも，僅か2例（0.6％）にすぎない．一方，ほぼ同期間の，食道鏡検査総数からみると，1,866例のうち2例で，0.1％にあたる（第2表）．

　今回は最近経験した食道平滑筋肉腫の1治験例を報告する．

　A 54 years old man, complaining since 3 months ago of dysphagia and slight epigastric pain, visited the authors' hospital. He could then eat soft food freely with normal appetite.

　At x-ray examination a shadow defect with serrated marginal contour about 7cm long was visualized in the middle third of the esophagus. By double contrast study it was seen as a large crater with notable marginal elevation. Endoscopy revealed an ulcerating tumor on the posterior wall 30 cm distal from the upper incisors, half encircling the esophageal wall. Both x-ray endoscopic diagnoses were esophageal cancer, but sarcoma was suspected by biopsy specimen.

　An ulcerating tumor measuring 5.5 by 4.0 cm, revealed in the resected specimen, was histologically diagnosed as leiomyosarcoma infiltrating into the muscle layer. Preoperatively the true nature of this tumor had barely been suspected only by biopsy.

　Of only 30 cases of esophageal sarcoma hitherto reported in Japanese literature, 10 were of leiomyosarcoma of the esophagus.

　Among 350 cases of malignants tumors of the esophagus resected for the past 3 years in the authors' clinic, leiomyosarcoma was found only in 2 cases.

　Some reference has further been made to its literature, both at home and abroad.