上咽頭リンパ上皮腫についての臨床的観察

LYMPHO-EPITHELIOMA OF THE NASOPHARYNX

　I．はじめに

　1921年にRégaud^1）とSchmincke^2）が別々にリンパ上皮腫の存在を提唱して以来，50年余の間，病理学領域においては，その分類，さらにはそれが独立した存在であるか否かに及ぶ論議が続けられており，現在のところでは一応，未分化の扁平上皮癌に属するとされている^3）4）。これは多数の症例を基礎にしたくわしい記載が従来なかつたことが原因であると思われる。

　Cappel^5）の分類によると，①リンパ球が浸潤して，明るい大型腫瘍細胞の核は胞状で核質に乏しく，核膜はよく染まり，好酸性の核小体が存在し，細胞境界は不明瞭で，小巣状か索状に増生し，未分化型細網肉腫に似たようにみえるSchmincke型，②胞巣が大きく，腫瘍細胞の上皮的性格が比較的明瞭なRégaud型，③胞巣が大きく，腫瘍細胞の壊死と間質の線維化を伴い，リンパ球の浸潤が少ない移行上皮癌型（Cappel）の3型にわかれるが，われわれが実際の標本を前にすると，腫瘍切片の採取部位（表在部より採取したか，深部より採取したか）により違つた型であつてみたり，さらには一つの標本内にこれらが共存したりすることも珍しくない。そのうえ，既照射などの条件でも変わつてくる。

　There were 57 cases of lymphoepithelioma that had been treated at the Head and Neck tumor Clinic of the University of Tokyo Hospital during the period of ten years, 1962-1973. Among these 38 cases were found to be growths of nasopharyngeal type.

　The ages of the patients ranged from 13 to 70 years. Among women, the majority of the affected were less than 40 years old. The tumors appeared to be nodular and flabby with a granular surface, harder than the reticulum cell sarcoma. Metastasis to the cervical glands was frequent which was easily diagnosed by palpation.

　As the present type of tumor showed a high radiosensitivity, radiotherapy was the treatment of choice. At the beginning of the treatment the tumors reacted similar to that of the reticulum cell sarcoma but, finally, the reactions were similar tothat of squamous cell carcinoma.

　During the course of treatment, there were numerous recurrences and metastasis but most patients survived for a number of years because the secondary irradiation treatments were quite effective. Seven patients died and the 6 of them died due to metastasis to the distant organs.

　There was little correlation of the prognosis with the involvement of cranial nerves. However, the prognosis appeared to be poor in those patients who were treated with cervical resection for metastatic growths.