良性との鑑別が困難であった下咽頭表在癌の1例

Superficial Hypophayrngeal Carcinoma which is Difficult to Distinguish from Pharyngeal Papilloma, Report of a Case

要旨　近年，従来発見困難であった中・下咽頭の表在癌が多く発見されるようになった．筆者らは乳頭腫との鑑別が困難であった下咽頭表在癌症例を経験したので報告する．患者は81歳，女性．早期胃癌に対する治療目的に当院へ紹介され，治療前の精査内視鏡検査時に下咽頭後壁に隆起性病変を認めた．内視鏡的に下咽頭乳頭腫と診断し，経過観察したが，腫瘤の増大傾向と，生検病理でも細胞異型の増悪を認めたため，全身麻酔下精査を施行した．下咽頭から食道入口に達する表在癌と診断し，ESD＋ELPSのhybrid内視鏡治療を施行した．病理組織学的にはsquamous cell carcinoma，INFa，EP，ly0，v0であった．

　Recent advances in endoscopic procedures, such as magnifying endoscopy and the NBI system have enabled precise observation of the pharynx. Diagnosis for pharyngeal papilloma is not difficult in many cases, but some cases of pharyngeal papilloma have abnormal vessels. In such cases, it is very difficult to distinguish between pharyngeal papilloma and pharyngeal superficial carcinoma. We encountered a case in which it was difficult to distinguish these two entities. An 81-year-old female was admitted to our hospital. Endoscopic examination revealed a slightly elevated lesion in the posterior wall of the hypopharynx. We diagnosed it as pharyngeal papilloma and followed it up with further observation. After one year of follow-up, the tumor size had grown, and the histological diagnosis for the biopsy sample indicated a neoplasitc tumor. Tumor location involved borderline lesions between the cervical esophagus and the hypopharynx. Hybrid endoscopic surgery（ESD and ELPS）was performed. Histological diagnosis was squamous cell carcinoma, T1a-EP, INFa, ly0, v0.