乳頭状巨大食道腫瘤の1例

A Giant Polypoid Tumor of the Esophagus: A case report

　食道にはポリープ状形態を示す腫瘍として，悪性黒色腫，癌肉腫，偽肉腫などが発生する．なかでも癌肉腫と偽肉腫は形態的にも特異な組織像を示し，臨床病理学的にもその鑑別は必ずしも容易でなく興味ある腫瘍である．ここにいわゆる癌肉腫と考えられた食道腫瘤を経験したので考察を加え報告する．

症例

　患　者：69歳　男性　無職

　既往歴：梅毒（44歳），肺結核（51歳），胃潰瘍（55歳）

　現病歴　1970年8月，耳痛，喉頭痛を訴えて治療を受けたことがある．その翌年，背部に痛みを感じるようになり，さらに嚥下障害が加わり，6月には全く食事の摂取が不可能となる．その上，吐血が加わり，本院外来を訪れ，内視鏡検査で食道にポリープ状腫瘤が発見され（Fig. 1），組織診の結果では扁平上皮癌と診断され日本医大常岡内科に入院した，入院時諸検査では，X線検査で食道中央部に乳頭状の巨大な腫瘤を認め（Fig. 2），その他の検査結果ではTable 1に示すように血液一般検査で，中等度から高度の貧血，糞便の潜血反応陽性，Wa-R陽性（ガラス板法，TPHA法）の他著変なく，入院後，腫瘤摘出不能ということで胃瘻造設術を受けたが3ヵ月後に肺炎を併発して死亡した．

　A 69-year-old man was admitted to our hospital with complaints of dysphagia and vague discomfort in the back. Upper gastrointestinal X-ray series and endoscopic study demonstrated a giant, inoperable polypoid tumor at the middle third of the esophagus. Three months later he died from combined bronchopneumonia. Autopsy revealed a polypoid tumor measuring 10×3×4 cm.

　Histologically, the tumor showed infiltrating squamous cell carcinoma composed of basal cells and spindle cells, accompanied with atypical spindle cells and multinuclear giant cells. The presence of these atypical spindle cells was confirmed as sarcomatous transformation of carcinoma cells, because fibroblastappearing rough endoplasmic reticulum was observed in the cytoplasm by electron microscopic examination. This tumor may be diagnosed as follows ; collision tumor, carcinoma with pseudosarcoma, carcinoma with benign stromal tumor (so-called carcinosarcoma) and/or anaplastic carcinoma.

　For monogenetic interpretation of the tumor, those diagnoses seemed to present an inappropriate terminology for the carcinosarcoma. Therefore, the previously reported literature are reviewed and the differentiation between carcinosarcoma and pseudosarcoma is discussed.