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Stomach and Intestine(Tokyo) Volume 48, Issue 13 （December 2013）

胃と腸 48巻13号（2013年12月発行）

Japanese English

症例

食道表在癌にpyogenic granulomaを合併した1例 First Report of Pyogenic Granuloma that Occurred in Superficial Esophageal Carcinoma 大林友彦 ¹ , 丹羽康正 ² , 田中努 ² , 田近正洋 ² , 近藤真也 ² , 水野伸匡 ¹ , 原和生 ¹ , 肱岡範 ¹ , 今岡大 ¹ , 山雄健次 ¹ , 菅野雅人 ^3,4 , 谷田部恭 ³ Tomohiko Obayashi ¹ , Yasumasa Niwa ² , Tsutomu Tanaka ² , Masahiro Tajika ² , Shinya Kondo ² , Nobumasa Mizuno ¹ , Kazuo Hara ¹ , Susumu Hijioka ¹ , Hiroshi Imaoka ¹ , Kenji Yamao ¹ , Masato Sugano ^3,4 , Yasushi Yatabe ³ ¹愛知県がんセンター中央病院消化器内科部 ²愛知県がんセンター中央病院内視鏡部 ³愛知県がんセンター中央病院遺伝子病理診断部 ⁴筑波大学医学医療系診断病理学研究室 ¹Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan ²Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan ³Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan ⁴Department of Diagnostic Pathology, University of Tsukuba, Tsukuba, Japan キーワード：食道表在癌 , pyogenic granuloma , ESD , 深達度 , IPCL Keyword: 食道表在癌 , pyogenic granuloma , ESD , 深達度 , IPCL pp.1961-1966

発行日 2013年12月25日 Published Date 2013/12/25

DOI https://doi.org/10.11477/mf.1403114033

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要旨　患者は60歳代，女性．上部消化管内視鏡検査にて，胸部食道に病変を指摘された．白色光観察では，径25mm大の発赤調の陥凹性病変の内部に，白色調の隆起成分を認めた．NBI併用拡大内視鏡観察では，陥凹部のIPCLは日本食道学会分類でType B1，隆起部のIPCLは不明瞭であった．隆起部は結節状で，EUSにより深達度はSM2と判断した．CTではリンパ節腫大，遠隔転移を認めず，cT1bN0M0，Stage Iと診断し，JCOG0508に登録のうえ，ESDを施行した．病理上，陥凹部はSCC，pT1a/LPM，20×19mm，ly0，v0，HM0，VM0で，隆起部は炎症細胞浸潤を伴った毛細血管の増生と拡張を認め，表面は白苔で覆われており，病理学的にPG（pyogenic granuloma）であった．これまで癌の内部にPGが発生した報告はなく，文献的考察を含めて報告した．

　A woman in her sixties with no symptom was found to have a tumor in her esophagus during screening EGD（esophagogastroduodenoscopy）. She was referred to our hospital for further examination and treatment of the esophageal tumor. The EGD showed a slightly depressed lesion with a smooth polypoid part inside in the lower esophagus. Iodine staining for both the depressed lesion and the polypoid part was unstained. CT showed neither lymph node nor distant metastasis. Endoscopic ultrasonographic images showed that the depressed lesion was localized in the mucosal layer but the polypoid part had invaded the submucosal layer. Biopsy specimen showed squamous cell carcinoma from the depressed lesion, but revealed no malignant cells with vascular proliferation from the polypoid part. We performed endoscopic submucosal dissection for this tumor which was 20×19 mm in size. Microscopically, the histological components for the depressed lesion and polypoid part were different from each other. That is, the depressed lesion was composed of squamous cell carcinoma with a depth of lamina propria mucosae. In contrast, the polypoid part was composed of proliferation of the capillaries with inflammatory cell infiltration located between the mucosal layer just below the necrotic tissue and the submucosal layer. Final histological diagnosis was squamous cell carcinoma with PG（pyogenic granuloma）.

　PG is known as a benign tumor with a polypoid form of hemangioma. The tumor usually occurs in the skin, and gastrointestinal involvement is extremely rare except for the oral cavity. The occurrence is considered to be a reactive change as a result of trauma. However, the precise pathogenesis still remains unknown. PG occurring in the carcinoma has not previously been described and our case is the first report of PG that occurred in esophageal carcinoma.