内容紹介
Summary
Esophageal carcinosarcoma is a rare malignant tumor. A 76-year-old man consulted near hospital about dysphagia. A gastrointestinal fiberscopy showed a stricture of the thoracic esophagus at approximately 34 cm from the incisor, and the macroscopic type of the tumor was 0-Ⅰp. Biopsy results indicated carcinosarcoma. The patient underwent esophagectomy and regional lymphadenectomy with gastric tube reconstruction by laparoscopy-assisted surgery and thoracotomy. Pathological examination of the surgical specimen revealed that the majority of the tumor was composed of spindle-shaped atypical cells, but because a very small transitional area between squamous cell carcinoma and sarcoma was noted, a diagnosis of carcinosarcoma was made. The depth of invasion was small, and no region lymph node metastasis was detected. We classified the tumor as pT1b(SM)N0M0, pStageⅠ. Immunohistochemically, the spindle-shaped sarcomatous cells displayed a positive reaction to vimentin and cytokeratin AE1/AE3. Ki-67(MIB-1)labeling index was high. The patient was discharged after an uneventful postoperative course and remains well as an outpatient at his 6-month follow-up. We report this case with a review of the literature.
要旨
食道癌肉腫は食道悪性腫瘍のなかでも比較的まれな疾患である。症例は76歳,男性。嚥下障害で当院を受診し,上部内視鏡検査で切歯34 cmに長径約10 cmの0-Ⅰp型の巨大腫瘍を認めた。食道癌肉腫の診断で,胸腔鏡下食道亜全摘術・2領域リンパ節郭清術・胸骨後経路頸部胃管吻合を予定した。術中に酸素化不良のため,開胸移行とし両肺換気下で手術を施行した。病理組織学的所見は,内腔にポリープ状に突出する120×70×50 mm大の腫瘍を認めた。cytokeratin(+),vimentin(+),SMA(+),desmin(+),S100(-),c-kit(-),CD34(-),Ki-67(+)で,表層の癌腫成分と腫瘍内部の肉腫成分の混在を認め,食道癌肉腫と診断した。最終診断はT1b(SM)N0M0,pStageⅠであった。本症例は深達度SMにもかかわらず食道狭窄を来すほどの食道内腔への発育を呈した点でまれと考え報告した。
目次
Esophageal carcinosarcoma is a rare malignant tumor. A 76-year-old man consulted near hospital about dysphagia. A gastrointestinal fiberscopy showed a stricture of the thoracic esophagus at approximately 34 cm from the incisor, and the macroscopic type of the tumor was 0-Ⅰp. Biopsy results indicated carcinosarcoma. The patient underwent esophagectomy and regional lymphadenectomy with gastric tube reconstruction by laparoscopy-assisted surgery and thoracotomy. Pathological examination of the surgical specimen revealed that the majority of the tumor was composed of spindle-shaped atypical cells, but because a very small transitional area between squamous cell carcinoma and sarcoma was noted, a diagnosis of carcinosarcoma was made. The depth of invasion was small, and no region lymph node metastasis was detected. We classified the tumor as pT1b(SM)N0M0, pStageⅠ. Immunohistochemically, the spindle-shaped sarcomatous cells displayed a positive reaction to vimentin and cytokeratin AE1/AE3. Ki-67(MIB-1)labeling index was high. The patient was discharged after an uneventful postoperative course and remains well as an outpatient at his 6-month follow-up. We report this case with a review of the literature.
要旨
食道癌肉腫は食道悪性腫瘍のなかでも比較的まれな疾患である。症例は76歳,男性。嚥下障害で当院を受診し,上部内視鏡検査で切歯34 cmに長径約10 cmの0-Ⅰp型の巨大腫瘍を認めた。食道癌肉腫の診断で,胸腔鏡下食道亜全摘術・2領域リンパ節郭清術・胸骨後経路頸部胃管吻合を予定した。術中に酸素化不良のため,開胸移行とし両肺換気下で手術を施行した。病理組織学的所見は,内腔にポリープ状に突出する120×70×50 mm大の腫瘍を認めた。cytokeratin(+),vimentin(+),SMA(+),desmin(+),S100(-),c-kit(-),CD34(-),Ki-67(+)で,表層の癌腫成分と腫瘍内部の肉腫成分の混在を認め,食道癌肉腫と診断した。最終診断はT1b(SM)N0M0,pStageⅠであった。本症例は深達度SMにもかかわらず食道狭窄を来すほどの食道内腔への発育を呈した点でまれと考え報告した。