原発性食道悪性黒色腫の2例

Primary Malignant Melanoma of the Esophagus, Report of Two Cases

　食道の原発性悪性黒色腫は，非常に稀な疾患である．1906年，Baur¹⁾の報告以来，1962年には，Waken²⁾らが，それまでに報告された22例に，彼らの2例を追加して分析報告している．本邦での報告は，数例^4)5)28)のみで，学会発表後抄録として記録されているにすぎない．1969年には，細田²⁹⁾らによる原発性悪性食道黒色腫の1剖検例の報告をみた．

　われわれは，1968年食道ファイバースコープによる生検によって，術前，悪性黒色腫と診断し，食道亜全剔術施行後，2年を経過するも健在である症例を経験した．この症例に，1967年4月食道噴門切除術を行なったが，1968年6月死亡した症例を追加して，食道原発性悪性黒色腫2例を報告する．

　Primary malignant melanoma of the esophagus is an extremely rare disease, and not more than 40 cases have been reported so far in the literatures of the world, including Japan.

　In this paper, two experienced cases of primary malignant melanoma of the esophagus are presented.

　The first case is a fifty-year-old male patient with chief complaint of swallowing difficulty. X-ray exmination showed an oval-shaped polypoid defect in the upper one third of the thoracal esophagus, and the diagnosis of malignant melanoma was made by esophagofiberscopic biopsy. On Aug. 9th 1968, subtotal esophagectomy was performed. In the resected specimen, there was seen a pedunculated mass, black in color, and measuring 4×2×1.5 cm. No lymph node metastasis was identified. The postoperative course was uneventful, and the patient has been well two years after operation.

　The second case was a sixty-two-year-old male patient with the chief complaint also of swallowing difficulty. X-ray showed an egg-sized defect in the lower one third of the thoracal esophagus which was suggestive of sarcoma. On Oct. 4th 1967, esophagocardiectomy was performed. The tumor was localized, dark-brown in color, and measured 6×5×4 cm. One lymph node metastasis was identified. Three months after operation, recurrent (left axillary lymph) node metastasis was confirmed, and the patient died one year and two months later due to cachexia.

　Histologically alveolar construction showing nevoid and/or epithelioid pattern was observed, and socalled junctional change was seen in the adjacent squamous epithelium.