食道のいわゆる癌肉腫の1例

Esophageal So-called Carcinosarcoma, Report of a Case

要旨　患者は55歳，男性．約4か月前から食物通過障害が出現し，食道腫瘍を指摘されて当院紹介となった．上部消化管造影および内視鏡検査所見では下部食道を中心とした長径約9cmの巨大な1型腫瘍を認めた．診断的EMRにて癌肉腫の診断となり，右開胸開腹胸部食道全摘，胸骨後経路頸部食道胃管吻合術を行った．病理組織検査にて，紡錘形細胞から成る肉腫様成分と扁平上皮癌が混在し，両者間に移行像を認めたことから“いわゆる癌肉腫”と診断された．術後3か月目に多発性肝転移，7か月目に肺転移が判明し，手術から約9か月後に癌死された．比較的まれな食道の“いわゆる癌肉腫”の1例を経験したので若干の文献的考察を加え報告する．

　The patient was a 55-year-old man who was found to have an esophageal tumor because of increasing dysphagia about four months ago. Barium swallow esophagogram and endoscopy demonstrated a large polypoid lesion in the lower thoracic esophagus. The size of this tumor was about 9 cm. Histological examination of the EMR specimen revealed that it was a carcinosarcoma. Thoracic esophagectomy with cervical, thoracic, abdominal lymph node dissection was performed. Histopathological findings showed squamous cell carcinoma and sarcoma-like proliferation of spindle-shaped atypical cells. A transitional feature was observed between the two sides. Therefore it was diagnosed as a so-called carcinosarcoma. Three months after the operation, both liver lobes had multiple metastatic lesions. Furthermore, four months later, the lung field had small metastatic lesions. The patient died nine months after his operation. Carcinosarcoma of the esophagus is a comparatively rare malignant tumor. We reported a case of esophageal so-called carcinosarcoma and reviewed some literature on the subject.