食道に限局したサルコイドーシスの1例

Localized Sarcoidosis in the Esophagus, Report of a Case

要旨●患者は70歳代，男性．経口摂取困難となったため近医を受診し，上部消化管内視鏡検査にて胸部食道に粘膜下腫瘍による全周性狭窄を認めたため，当院に紹介され受診となった．PET-CT検査では胸部上部・中部食道に壁肥厚を認め，同部にSUVmax＝14.6のFDG集積，左右肺門部にもFDG集積を認めた．2度にわたり生検を施行したが確定診断に至らず，PET陽性食道粘膜下腫瘍の診断の下，食道亜全摘術を施行した．病理組織学的に非乾酪性類上皮細胞肉芽腫を形成している像が多数あり，Langhans型巨細胞も多数認められ，食道原発サルコイドーシスに矛盾しない所見であった．

　A 76-year-old man with severe progressive dysphagia was previously diagnosed with a submucosal tumor and was referred to our hospital for further examination and treatment because biopsy specimens revealed non-specific inflammation. Endoscopic examination at our hospital revealed constriction of the entire circumference of the esophagus measuring 6cm in diameter and located 27cm distal to the incisors. The constricted region was not covered with non-neoplastic epithelium. Positron emission tomography─computer tomography further revealed irregular thickening of the upper to middle esophagus, whereas radiolabeled［18F］-2-fluoro-2-deoxy-D-glucose uptake demonstrated significant accumulation in the bilateral hilar areas（maximum standardized uptake value was 14.6）. Pathological findings from an open biopsy were unable to confirm sarcoidosis resulting from the malignant disease. For definitive diagnosis and treatment, we performed radical esophagectomy. Histopathological findings revealed epithelioid cell granulomas with multiple Langhans giant cells without caseation and were thus compatible with sarcoidosis.