A case of esophageal carcinoma associated with sarcoidosis

症例は66歳男性.胸やけで近医を受診し精査･加療目的で当院を紹介された.中部食道に広範囲の扁平な隆起病変が存在し生検の病理検査で扁平上皮癌と診断された.両側肺門,縦隔,右鎖骨上窩,腹部大動脈右側にリンパ節腫大があり,右鎖骨上窩のリンパ節生検の病理検査で非乾酪性の肉芽腫が認められサルコイドーシスが示唆された.食道癌とサルコイドーシスの併存が疑われ,術前2コースのFP(Cisplatin+fluorouracil)療法を行ったが,その治療効果はNCと判断され,その後に食道亜全摘術が施行された.術後経過良好にて術後19病日目に軽快退院された.術後weekly FP(Nedaplatin+ fluorouracil)療法を5回追加投与した.食道癌とサルコイドーシスの併存やサルコイド反応を伴う食道癌はいずれも稀とされる.CTやPETにおける縦隔や肺門リンパ節の多発腫大･高集積はサルコイド反応や炎症性疾患が併存している場合もあり注意が必要である.またこれらを安易に癌のリンパ節転移と誤診し手術不能と判断するのは好ましくない.可能な限り術前にリンパ節生検で鑑別診断することが重要である.

A 66-year-old man was admitted because of chest burning sensation. Endoscopic examination revealed mass lesion at the middle esophagus. Endscopic biopsies revealed squamous cell carcinoma. Preoperative CT and PET showed swollen lymph nodes of the bilatetal hilar lesions, mediastinum, abdomen and right supraclavicular lesion. The supraclavicular lymph nodes was extirpated. Noncaseating epitheloid cell granulous could be seen in the specimen, suggesting sarcoidosis. Chemotherapy using FP(Cisplatin and fluorouracil)regimen reduced accumulation of the PET, but multiple lymph node swellings being not changed. However, the patient underwent esophagectomy with D2 dissection. The resected specimen showed metastasis in only one lymph node, but noncaseating granuloma were seen in some lymph nodes. The patient discharged on 19th days after the operation, and he received 5 times of adjuvant chemotherapy using weekly FP(Nedaplatin+ fluorouracil)regimen. The coexistence of esophageal carcinoma and sarcoidosis and sarcoid reaction is rare, but when regional lymphadenopathy is newly found by radiological examination such as PET-CT, the possibility of systemic sarcoidosis and sarcoid reaction should be considered. In addition, we must not misdiagnose the findings as the advanced stage of esophageal cancer. Differential diagnosis by using the detailed examination is important.

サルコイドーシス

食道癌

FDG-PET

サルコイド反応