内容紹介
Summary
The patient was a 64-year-old man who presented with a hoarse voice, pharyngalgia, and high fever. Despite receiving therapy, he presented with dysphagia, and endoscopy revealed a tumor in the thoracic esophagus. A biopsy indicated squamous cell carcinoma. Despite no evidence of infection, laboratory findings revealed leukocytosis and high serum levels of granulocyte-colony stimulating factor(G-CSF). An immunohistochemical study showed positive staining for G-CSF in the tumor cells. Chemoradiation therapy(CRT)with 5-fluorouracil and cisplatin was administered, but his response to treatment was evaluated as progressive disease. Bone, brain, and liver metastases were detected consecutively, and he died 7 months after diagnosis. There are few reports of G-CSF-producing esophageal tumors, and the prognosis is very poor.
要旨
症例は64歳,男性。声のかすれ,咽頭痛,発熱を主訴に近医を受診するが症状は軽快しなかった。その後,食後のつかえ感が出現し,上部消化管内視鏡検査にて胸部食道扁平上皮癌の診断となった。白血球は異常高値であり,血清granulocyte-colony stimulating factor(G-CSF)値が高値を示し,生検標本の免疫染色にて抗G-CSF抗体陽性であったため,G-CSF産生胸部食道扁平上皮癌と診断した。切除不能と判断し,化学放射線療法を施行した。治療効果判定のCT検査では原発巣は縮小したが骨転移を認め,その後に脳転移,肝転移が出現し,診断後7か月にて癌死した。食道原発のG-CSF産生腫瘍はまれな疾患で悪性度が高く予後不良とされており,治療の困難さを再認識させられた。
目次
The patient was a 64-year-old man who presented with a hoarse voice, pharyngalgia, and high fever. Despite receiving therapy, he presented with dysphagia, and endoscopy revealed a tumor in the thoracic esophagus. A biopsy indicated squamous cell carcinoma. Despite no evidence of infection, laboratory findings revealed leukocytosis and high serum levels of granulocyte-colony stimulating factor(G-CSF). An immunohistochemical study showed positive staining for G-CSF in the tumor cells. Chemoradiation therapy(CRT)with 5-fluorouracil and cisplatin was administered, but his response to treatment was evaluated as progressive disease. Bone, brain, and liver metastases were detected consecutively, and he died 7 months after diagnosis. There are few reports of G-CSF-producing esophageal tumors, and the prognosis is very poor.
要旨
症例は64歳,男性。声のかすれ,咽頭痛,発熱を主訴に近医を受診するが症状は軽快しなかった。その後,食後のつかえ感が出現し,上部消化管内視鏡検査にて胸部食道扁平上皮癌の診断となった。白血球は異常高値であり,血清granulocyte-colony stimulating factor(G-CSF)値が高値を示し,生検標本の免疫染色にて抗G-CSF抗体陽性であったため,G-CSF産生胸部食道扁平上皮癌と診断した。切除不能と判断し,化学放射線療法を施行した。治療効果判定のCT検査では原発巣は縮小したが骨転移を認め,その後に脳転移,肝転移が出現し,診断後7か月にて癌死した。食道原発のG-CSF産生腫瘍はまれな疾患で悪性度が高く予後不良とされており,治療の困難さを再認識させられた。