腹臥位胸腔鏡下に切除した食道神経鞘腫の1例

A case of thoracoscopic enucleation in the prone position for schwannoma of the esophagus

◆要旨：食道良性腫瘍の中でも極めて稀な食道神経鞘腫に対して腹臥位胸腔鏡下腫瘍核出術を施行した症例を経験した．患者は69歳，女性．2014年頃よりつかえ感を自覚し，徐々に増悪したため，2016年に近医より当科へ紹介され受診した．胸腹部造影CT検査にて気管分岐部背側に30mm大の腫瘤を認め，食道原発腫瘍が疑われた．上部消化管内視鏡検査では，胸部中部食道に30mm大の粘膜下腫瘍を認めた．Endoscopic ultrasound-fine needle aspiration （以下，EUS-FNA）を施行し，細胞診より非上皮性腫瘍が疑われたが，確定診断には至らなかった．有症状かつ本人の希望もあり，腹臥位胸腔鏡下腫瘍核出術を施行した．切除材料の病理組織学的検索により神経鞘腫と診断された．ここに考察を加えて報告する．

We experienced a case of thoracoscopic enucleation in the prone position for schwannoma of the esophagus, which is an extremely rare procedure for a benign esophageal tumor. A 69-year-old female presented at our hospital in 2016 with a history of dysphagia that had been gradually worsening since 2014. Abdominal and chest enhanced computed tomography showed a tumor of approximately 30mm diameter at the dorsal aspect of the carina tracheae. We suspected that the primary tumor was located in the esophagus. Upper gastrointestinal endoscopy revealed a 30mm submucosal tumor in the middle thoracic esophagus. Cytodiagnosis using endo ultrasound-fine needle aspiration indicated a suspected non-epithelial tumor, but definitive diagnosis was not reached. We performed thoracoscopic enucleation in the prone position, as the patient requested surgical treatment. The tumor was diagnosed as a schwannoma based on the pathological examination of resected material. Herein, we report the details of our case and present a review of the exiting literature.