皮膚筋炎を伴った膵癌食道転移の1例

A Case of Dermatomyositis and Pancreas Cancer with Metastasis to the Esophagus

　中年以降の皮膚筋炎には悪性腫瘍が高率に合併する^1～5)15)．しかしその多くは胃癌などで，膵癌の合併例は稀である．近年，遠隔臓器癌の胃転移の報告が散見されるようになってきたが⁶⁾¹⁶⁾，食道転移の報告は少なく，本邦報告例は戦後7例^{7)8)17)～19)}にすぎない．膵癌食道転移の報告例は内外とも非常に少ない⁸⁾⁹⁾．

　著者らは最近皮膚筋炎例の食道にⅡa＋Ⅱc様の小癌巣を認め，剖検上それが膵体部癌の食道転移であった例を経験したので報告する．

症　例

　患　者：71歳　男　会社役員

　主　訴：皮疹と瘙痒

　家族歴・既往歴：特記すべきものなし

　現病歴：1975年11月頃より顔面・手背に発赤腫脹，両手背の潰瘍が出現，12月には肘・膝関節突起部の上面にも紅斑びらんが出現，嗄声となり，某病院で加療したが軽快せず，微熱もみられるようになり，1976年2月16日，本院皮膚科に入院した．体重減少，黄疸，腹痛はない．

　A 71-year-old man was admitted to the hospital because of erythema on his hands, face and trunk. Besides skin manifestations physical findings were unremarkable. Laboratory examinations on admission were within normal limits. In the course of hospitalization, muscle weakness occurred especially in the extremities and serum CPK increased from 29 to 146 units. Dermatomyositis was suspected and malignant tumors were searched. Barium enema revealed no abnormality but upper GI series disclosed a protruded lesion of the esophagus, suggestive of primary esophageal cancer. Esophagoscopic examination also showed a flat protrusion with central depression and cancer tissue was taken by biopsy. As he had a sudden bout of severe thrombocytopenia and bleeding tendency, disseminated intravascular coagulation was suspected. He died of lower GI bleeding soon after. Autopsy revealed a 4 X 3 cm sized cancer of the pancreas body with metastasis to the esophagus, generalized hemorrhagic tendency and typical findings of dermatomyositis.