食道原発悪性黒色腫の1例

Primary Malignant Melanoma of the Esophagus, Report of a Case

要旨　患者は，食思不振を主訴とする61歳，男性．上部消化管内視鏡検査で，胸部中部～下部食道に内腔を占居する軟らかい易出血性の腫瘍を認めた．立ち上がり急峻な亜有茎性隆起を呈し，分葉状の表面は黒色調で，光沢感を有していた．周囲粘膜にも黒色色素沈着を伴っており，生検で悪性黒色腫と診断した．胸腹部CTで肺門部・胃小彎側周囲・傍大動脈周囲リンパ節への転移と，多発右肺転移を認め，食道癌に準じた進行度はT3 N4 M1（肺），stage IVと診断した．通過障害に対して放射線照射を行い，また，全身化学療法としてダカルバジン単剤療法を行った．治療開始後4か月の時点で，原発巣の縮小および肺転移の消失が得られており，経口摂取も可能な状態で経過している．

　A 61-year-old man was observed in our hospital because of dysphagia and weight loss. Upper gastrointestinal endoscopy showed a large sessile polypoid tumor in the mid to lower thoracic esophagus. It was lobulated and black in color, and possessed a glossy surface. Pigmentation of its surrounding mucosa was also noted. The biopsy confirmed the diagnosis of a malignant melanoma. CT（computed tomography）of the chest and abdomen revealed metastases to the pulmonary hilar, perigastric, and para-abdominal aortic lymph nodes, and to the right lung. The clinical stage according to the tenth edition of the Japanese Esophageal Society's guide line on Carcinoma of the Esophagus was IV（T3 N4 M1）. After completion of local radiotherapy and systemic chemotherapy（dacarbazine, 4cycles）, CT scans showed significant reduction of the primary tumor and affected lymph nodes, and disappearance of the pulmonary nodules.