炭粉沈着症により腫大したリンパ節が食道腔内に露出し内視鏡的に食道原発性悪性黒色腫が疑われた1例

Tumorous Lesion of the Esophagus Endoscopically Simulating Primary Malignant Melanoma of the Esophagus, Report of a Case

要旨　患者は73歳，女性．胃ポリープで毎年内視鏡的経過観察を続けてきたが，1987年の定期検査で，食道の上門歯列より25cmの部位に黒色の色素を有する表面平滑な限局性の腫瘤性病変が認められた．病変は中心に潰瘍を伴っており，内視鏡的に食道原発性悪性黒色腫が疑われた．生検組織は炭粉を含む炎症性肉芽で悪性所見は認められなかったが，臨床経過，UGI，CTなどで腫瘍性病変が否定できなかったため開胸術を施行した．手術所見としては，腫大した気管分岐部のリンパ節が直接食道筋層を貫き，食道腔内に露出していたことが判明した．病理組織検査では炭粉沈着と強い硝子化を伴う瘢痕様リンパ節であった．

　A 73-year-old woman, who had annually received follow-up examination of a gastric polyp by endoscopy since 1980, was found to have a tumorous lesion of the esophagus simulating primary malignant melanoma of the esophagus, on June 2, 1987. Endoscopic view disclosed a Borrmann 2-like lesion located on the anterior right side wall of the esophagus at 25 cm from the incisors. The color of the lesion was partly dark, and its marginal wall was relatively smooth and lustrous. Biopsy specimens taken from the lesion showed inflammatory granulation with anthracosis.

　However, thoracotomy was performed because the possibility of tumor of the esophagus was not entirely excluded by further examination. At operation, a swollen lymph node at the subcarina was found directly invading the external wall of the esophagus, penetrating through the esophageal muscle layer and becoming apparent in the lumen of the esophagus.

　Microscopically, the lymph node showed anthracosis with hyaline degeneration.

　Although extremely uncommon, this case should be kept in mind as one of the lesions of the esophagus which may be darkly pigmented, but which is not necessarily primary malignant melanoma of the esophagus.