Departmental Bulletin Paper 術後長期無再発生存中の表在型食道内分泌細胞癌の1例
A Case of Superficial Endocrine Cell Carcinoma of Esophagus with Long-term Recurrence-free Survival after Surgery

寺島, 哲郎  ,  須田, 武保  ,  角田, 知行  ,  佐々木, 正貴  ,  味岡, 洋一  ,  Terashima, Tetsuro  ,  Suda, Takeyasu  ,  Kakuta, Tomoyuki  ,  Sasaki, Masataka  ,  Ajioka, Youichi

129 ( 5 )  , pp.273 - 280 , 2015-05 , 新潟医学会
食道内分泌細胞癌は比較的まれな疾患で, 予後はきわめて不良であり, 標準治療は確立されていない. 症例は70歳, 男性. スクリーニング目的の上部内視鏡検査で切歯裂より38cmに軽度扁平隆起を認め, 生検にて食道内分泌細胞癌と診断された. 術前胸腹部CT検査上はリンパ節及び遠隔転移は認めなかった. 以上より手術は経裂孔食道切除D1郭清術を行った. 病理診断は内分泌細胞癌, pSM3, ly0, v2, im(-), pN0 であった. 免疫組織化学的検査ではNCAM陽性, p53蛋白過剰発現, Ki-67 labeling index は55%であった. 術後は食道扁平上皮癌に準じて High dose CDDP + 5FU 療法を3コース行った. 術後7年経過した現在, 無再発生存中である. 手術適応については意見の分かれるところであるが, 予後の向上には手術を含めた集学的治療が有効と考えられた.
Endocrine cell carcinoma (ECC) of the esophagus is a rare form of esophageal carcinoma, has a poor prognosis, and yet has no standard therapy. A 70-year-old-man was found in endoscopic examination for screening to have a flat-elevated lesion at the middle thoracic esophagus. Pathological examination of biopsy specimens showed ECC. Thoracoabdominal enhanced CT detected neither lymph node metastases nor distant organ metastases. We conducted transhiatal radical esophagectomy with D1 lymph node dissection and retrosternal reconstruction by a gastric tube. Histopathologically, the tumor was evaluated as pSM3pN0IM0H0P0 StageI based on Classification of Esophageal Carcinoma. Immunohistochemically, overexpression of p53 protein, NCAM positive cells and diffuse Ki-67 positive cells (labeling index: 55%) were observed in the tumor. The tumor was definitively diagnosed ECC of the esophagus. As adjuvant chemotherapy, 3 courses of chemotherapy with High dose CDDP and 5FU, was performed. He remains alive without evidence of recurrence in the 7years as of this writing. This case suggests that radical resection and adjuvant chemotherapy could be an effective teatment for ECC of the esophagus.

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