下喉頭の“いわゆる癌肉腫”を合併した食道多発表在癌の1例

Multicentric Superficial Esophageal Cancer with So-called Carcinosarcoma of Hypopharynx, Report of a Case

要旨　下咽頭の“いわゆる癌肉腫”を合併した食道多発表在癌の1例を経験し，報告した，患者は51歳，男性，主訴は嚥下困難．下咽頭腫瘤と診断され当院耳鼻科にて腫瘤摘出術を施行した．組織診断は“いわゆる癌肉腫”であった．腫瘤摘出後に施行した食道透視で食道全体に多発する粘膜不整像を認め，内視鏡で多発性の食道粘膜粗糙，表在性凹凸不整像を認めた．生検で中分化扁平上皮癌と診断し，咽頭・喉頭・食道全摘，後縦隔経路咽頭胃吻合術を施行した．食道は粘膜内癌が多発しており，一部粘膜下層への浸潤を認めた．下咽頭の“いわゆる癌肉腫”は粘膜下層まで浸潤していた．食道および下咽頭に癌肉腫と癌が重複することはまれで文献的考察を加え報告した．

　The patient, a 51-year-old male, was admitted to our hospital with a complaint of slight disphagia. Laryngoscopy showed two hypopharyngial tumors (Fig. 1a, b). After these tumors were resected, histologic observation of the resected materials showed ‘so-called carcinosarcoma' (Fig. 2a, b). X-ray examination (Fig. 3) revealed rough mucosal folds of thoracic esophagus and endoscopic examination (Fig. 4a, b) showed superficial irregularity of esophageal mucosa and multiple residual islands with iodine staining. Histologic examination of the biopsy specimens suggested moderately differentiated squamous cell carcinoma (Fig. 5). Pharyngo-laryngo-esophagectomy with right thoracotomy and reconstruction using stomach was performed (Fig. 6a, b). Histopathologic observation of the resected materials showed multicentric squamous cell carcinoma scattered in the whole esophagus. In the major part of the esophagus, the lesions had invaded only the mucosal layer, but, in the part of the esophagus, near the squamo-columnar junction and the hypopharynx, the submucosal layer had been invaded (Figs. 7 and 8).