食道顆粒細胞腫

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タイトル別名
  • Granular Cell Tumor of the Esophagus
  • Pathological Study of a Surgical Case
  • 1手術例の病理学的検討

抄録

A case of granular cell tumor of the esophagus is presented. The patient is a 51-year-old man, who developed dysphagia and loss of appetite with symptoms of the common cold. Rentgenographic and endoscopic examination of upper gastro-intestinal tract revealed findings consistent with carcinoma of the esophago-cardiac region, and esophago-cardiectomy was performed. Pathological examination of resected specimen revealed tubular adenocarci noma of the esophagocardiac region. In collision with adenocarcinoma, a small submucosal tumor of the esophagus, measuring 10 x 5 x 5 mm, was detected incidentally.<BR>This small tumor showed typical histopa thological features of granular cell tumor. Tumor cells had small, round nuclei and abundant, eosinophilic cytoplasm which contained numerous PAS positive granules, and were arranged in clusters or cords. A portion of the stroma showed myxomatous change. S-100 protein was demonstrated in cytoplasm of tumor cells immunocytochemically. So-called “angulate body cells” were scattered in the stroma of this tumor. These cells had neither S-100 protein nor lysozyme in their cytoplasm.<BR>Ultrastructurally, cytoplasm of tumor cells (“granu lar cells”) were filled up with numerous autophagolysosomes which contained laminated fragments of membranous structure, electrondense granules and electron-dense bodies in various proportion. “Angulate body cells” contained saccular structures in their cytoplasm which were packed with microtubules-like, tubular structures 13-16 nm in diameter. No transitional or intermediate cells between tumor cells (“granular cells”) and “angulate body cells” were detected.<BR>Granular cell tumor arising in the eso phagus is rare and heretofore only about 20 cases are reported in Japan. Histogenesis of this tumor is still obscure, but the theory of Schwann cell origin is widely accepted in recent years. Demonstration of S-100 protein in cytoplasm of the tumor cell in our case provides further evidence supporting this theory. So-called “angulate body cells”, which appear characteristically in the stroma of this tumor, contain glycolipid and do not show the characteristics of histiocyte or tumor cell. Origin and significance of this peculiar cell still remains to be elucidated.

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