食道のいわゆる癌肉腫の1例 A CASE OF SO-CALLED CARCINOSARCOMA OF THE ESOPHAGUS

Access this Article

Author(s)

Abstract

胸部上部食道に発生し組織学的検討の結果,いわゆる癌肉腫と診断した症例を経験したので報告する.症例は71歳,男性で嚥下困難を主訴に来院した.食道造影,内視鏡検査で上部食道に全周性の狭窄を伴う隆起性病変を認めた.生検の病理組織では多形性の強い紡錘型細胞を主体とする細胞が増殖し,肉腫と診断した.食道癌取扱い規約での手術的進行度はSt IV,切除度はR III,根治度はCIであった.切除標本で腫瘤は8×4×2cmで,組織像は腫瘤部分で紡錘型細胞が肉腫様構造をとり一部に扁平上皮癌が混在していた.免疫染色で肉腫様成分においても上皮性マーカーであるEMA (epithelial membrane antigen)が陽性であったことより紡錘型細胞が上皮細胞に由来することが示唆され,いわゆる癌肉腫と診断した.本症例は3群のリンパ節転移を認めていた.食道癌と同様に癌肉腫に対しても,全身状態を考慮して拡大郭清を伴う積極的な手術療法が必要と考えた.

Carcinosarcoma of the esophagus is a rare malignant neoplasm composed of both carcinomatous and sarcomatous elements. The patient, a 71-year-old male, presented with swalling difficulties. A large tumor was found on radiologic imagings in the upper thoracic esophagus, and sarcoma was diagnosed by endoscopic biopsy. Thoracic esophagectomy was followed by cervical, mediastinal and abdominal lymph node dissection. The polypoid tumor, 8 × 4 × 2 cm in size, was composed of carcinomatous and sarcomatous elements histologically. Additional immunohistochemical examinations disclosed EMA (epithelial membrane antigen) and Vimentine-positive cells in the sarcoma-like element. According to the Guide Lines for Clinical and Pathological Studies on Carcinoma of the Esophagus, this case was diagnosed as so called carcinosarcoma. Cervical para-esophageal lymph node metastasis was histologically confirmed. Radical esophagectomy with lymph node dissection may be recommended for carcinosarcoma of the esophagus if permited by the general condition of the patient.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 59(1), 122-126, 1998

    Japan Surgical Association

Codes

  • NII Article ID (NAID)
    130003432326
  • Text Lang
    UNK
  • ISSN
    1345-2843
  • Data Source
    J-STAGE 
Page Top