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はじめに
頸部腫瘤をきたす悪性腫瘍は,頭頸部領域原発腫瘍や悪性リンパ腫が多く,一部の肺癌や食道癌を除けば胸腹部領域からの遠隔転移は少数である。また,頸部全体に結合織の増殖を伴ってび漫性に転移をきたし,進行性線維腫症ともいえる病態を呈することは稀である。今回われわれは,頸部および鼠径部を中心に発生した高度の進行性線維腫症の原因が,胃低分化型腺癌の遠隔転移であったと剖検で初めて診断された症例を経験した。頸部進行性線維腫症の原因の1つとして悪性腫瘍を念頭におく必要があることを痛感し,また血中サイトカインの分析から,線維腫症の成因として胃癌細胞の産生する塩基性線維芽細胞増殖因子(basic fibroblast growth factor:以下,bFGFと略)などの関与が強く示唆されたので,若干の文献的考察を加えて報告する。
A 51-year-old woman complained of mild dysphagia and a diffuse swelling of the neck. There were no abdominal symptoms. Biopsy specimens taken from the neck and inguinal resion showed diffuse fibromatosis and no evidence of malignant changes. Serum examination revealed elevated bFGF and PDGF levels and positive antinuclear,anti-ssDNA and anti-dsDNA antibodies. Autoim-munological mechanism was considered to be most likely etiology. However, immunosuppressive ther-apy failed to relieve her symptoms. Three months after occult blood was detected in stool and gastric fiberscopy confirmed a diagnosis as gastric scirr-hous carcinoma. She died of multiple organ failure due to carcinoma 6 months after admission. Meticu-lous reexamination of the biopsy specimen reveal-ed the scattered distribution of highly degenerat-ed cancer cells. Elevated serum levels of bFGF and PDGF produced from cancer cells in the neck probably contributed to formation of progres-sive fibromatosis.
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