嚥下困難を初発症状とした気管膜様部腺様嚢胞癌の1例 [in Japanese] A Case of Adenoid Cystic Carcinoma in the Trachea Complaining of Dysphagia [in Japanese]
Access this Article
Search this Article
気管原発の腫瘍の約半数は腺様嚢胞癌が占めるが, 気管腫瘍の発生頻度は低く, 気管, 気管支, 肺の悪性腫瘍の0.5%以下である。今回, われわれは診断に難渋した気管膜様部腺様嚢胞癌の1例を経験したので, 若干の文献的考察を加えて報告する。<br>症例は62歳, 男性, 主訴は嚥下困難。初診時, 耳鼻咽頭, 頸部に異常所見を認めず, 左声帯の軽度の可動制限を認めた。CT, MRIにて気管後方, 頸部食道右側, 椎体前面に大きさ40×30 mm大, 境界明瞭, 内部不均一に造影される腫瘤を認めた。当初は食道由来の良性腫瘍を疑ったが, 頻回の穿刺吸引細胞診にてclass V, 腺癌疑いの結果を得た。タリウムシンチにて早期相では病変部に一致して取込みを認め, 遅延相にて排泄が不良であった。甲状腺機能, intact PTH, PSAは正常範囲であった。以上より, 甲状腺濾胞癌をまず疑い, 術前放射線療法ののち, 甲状腺全摘術, 腫瘍摘出術, 気管切開術を施行した。摘出標本にて腺様嚢胞癌の診断を得た。術後, 追加照射を施行したが, 多発性骨転移, 肺転移も出現したため, 死亡した。本症例のように壁外性に浸潤するタイプの気管原発の腺様嚢胞癌は診断に苦慮することが多く, 注意を要すると考えられた。
Although adenoid cystic carcinomas comprise half of all tumors of the trachea, the incidence of tracheal tumors itself is low, and tumors of the trachea, the tracheal branches and lungs comprise less than 0.5% of all malignant tumors. We encountered a case of tracheal adenoid cystic carcinoma that was difficult to diagnose, and we accordingly report some additional documentation for consideration.<br>A 62-year-old male visited our hospital complaining of dysphagia. There were no abnormal findings in the ears, nose, pharynx, or neck, but his left vocal cord mobility was limited. A tumor surrounding the trachea and extending to the right lobe of the thyroid was revealed by computed tomography and magnetic resonance imaging. Our initial diagnosis was a benign tumor in the esophagus. We performed fine needle aspiration cytology under ultrasonography, and we made a diagnosis of class V adenocarcinoma. In thallium scintigraphy, a shadow indicating the tumor was found in the early phase and wash-out of the shadow was poor in the delayed phase. The thyroid function, intact PTH, and PSA were within the normal ranges. Accordingly, our preoperative diagnosis was thyroid follicular carcinoma. After preoperative irradiation, a total thyroidectomy and extraction of the tumor were performed. A diagnosis of adenoid cystic carcinoma was made based on examination of the surgical specimen. Although additional irradiation was performed, multiple bone metastasis and lung metastasis occurred, and the patient died. As we report here, adenoid cystic carcinoma of the trachea showing external growth as in this case is very difficult to diagnose.
- The Journal of the Japan Broncho-esophagological Society
The Journal of the Japan Broncho-esophagological Society 56(6), 489-494, 2005-12-10
The Japan Broncho-esophagological Society