鼻副鼻腔の乳頭腫および乳頭癌の臨床ならびに病理組織学的研究

PAPILLOMA AND PAPILLARY CANCER IN THE NOSE AND PARANASAL SINUSES

　I．緒言

　鼻副鼻腔の乳頭腫は一般に比較的良性の腫瘍とみなされているが，しばしば再発し，かつ癌腫への移行例も報告^1）-15）されており，実際に病理組織学的にみて，良性の乳頭腫か悪性の乳頭腫か明らかに判別し得ない例^9）16）も少なくない。

　われわれはかつて，鼻副鼻腔乳頭腫6例について検討し，そのうち1例は癌腫として再発死亡し，他の1例は切除組織を再検した結果，悪性とみなされる所見があつたことを報告した。それ以来約10年，鼻副鼻腔の乳頭腫および乳頭状に増殖した上皮内癌より進展したと思われる，いわゆる乳頭癌について臨床的，病理組織学的に検討を進めてきたが，現在まで，初診時より乳頭腫として加療したもの3例，乳頭癌として加療したもの9例，計12例について色々比較検討した結果，若干の知見を得たので，ここに発表する。

　Clinical and pathohistological studies were made on three cases of nasal and sinal papilloma and nine cases of papillary cancer during the period of past 10 years in our clinic.

　The chief complaint in both of these neoplasms was mostly nasal obstruction with polypoidgrowths while, bony destructions of the maxillary sinus were found by x-ray examination in several cases of both types. Symptom manifestions appeared to be more severe in cases involved with papillary cancer.

　Three cases affected with papilloma were treated by partial resection of the maxilla; and, all of them are still alive 5 years after the operation. Nine cases of papillary cancer were treated with a combined therapy of surgery, irradiation and administration of anticancerous drugs. Among this group 6 cases are still living 3 years after the initial treatment.

　Pathological studies on the resected specimens revealed inverted papillary proliferations of the epithelial layers in cases of papilloma as well as those of papillary cancers. In the former the proliferated epithelium consisted of basal cell-like uniformly sized cells while, the latter that of malignant types. However, there was one cell which appeared to be a transitional cell carcinoma and the cell proliferation could hardly be distinguished from that of benign papilloma.

　In view of these finding we propose a radical treatment even in cases of simple papilloma.