西野 宏

上顎洞癌に対する集学治療の主たる治療は切除手術と考える。当科で施行されている分割切除による腫瘍全摘出術を呈示する。手術は顔面皮膚切開をおかずに上顎歯肉部を切開しおこなう。腫瘍組織を覆う被膜様線維組織を確認し,剥離操作を行うことが手術操作のポイントである。可能なかぎり腫瘍組織に切り込まずに腫瘍組織を周囲より剥離摘出する。広範囲に眼窩底骨や骨膜が切除された場合には残存骨膜を絹糸でできるだけよせ,眼球の下方への偏位を少なくする。頭蓋底の骨欠損を認め硬膜に腫瘍組織が接する場合には,手術用顕微鏡下に硬膜と腫瘍組織を剥離する。

頭頸部癌に重複した食道表在癌治療経験を報告した.対象は,1992年〜2003年5月までに治療した8例(全例男性,平均59歳)であった.頭頸部癌は下咽頭癌4例,喉頭癌2例,甲状腺癌,舌癌各1例で,甲状腺乳頭癌を除き全てが扁平上皮癌であった.治療は放射線照射を主体とした集学的治療を施行した.表在癌発見の契機は頭頸部癌治療前のスクリーニング時が5例,頭頸部癌治療後の定期検査による内視鏡検査が2例,表在癌治療後の下咽頭癌発見が1例であった.占拠部位はMtが4例,Ltが2例,UtとCeが各1例で,深達度はsmが2例,m3が2例,m2以下が4例であった.治療は内視鏡的粘膜切除術が4例,根治術が2例,放射線治療が2例であった.転帰は2例に下咽頭癌死を認めたが,表在癌による死亡はなかった.なお,頭頸部癌(喉頭癌)に重複した進行食道癌7例では,頭頸部癌治療後3年以上経過してからの発見(6例)で,原病死5例と極めて予後不良であった

A 64-year-old man with well-differentiated squamous cell carcinoma of the maxilla who presented with high levels of granulocyte-colony stimulating factor (G-CSF) is described. The extent of the tumor was staged as T4N1M0. Regional chemotherapy, radiotherapy and resection of the tumor were performed. The patient died of local recurrence and lung metastasis about four months after admission. During his clinical course, a peripheral blood analysis demonstrated marked granulocytosis and high G-CSF activity. G-CSF producing cancer cells were immunohistologically observed in the primary lesion and metastatic lymph nodes. Therefore, he was diagnosed with G-CSF producing maxillary cancer. The cancer tissue from this patient was transplanted into nude mice, and one of these mice demonstrated distant metastasis to the lung.

口腔内のアフタ性潰瘍を生じた後, 瘢痕組織による咽頭狭窄を呈した1例を報告する.<BR>瘢痕組織内と喉頭蓋に肉芽腫が認められた. しかし, 肉芽腫を生じうる既知の疾患は否定的で, 類似症例に報告されているベーチェット病も否定的であつた. CO₂ レーザーにて瘢痕組織を除去し, 術後, プレドニゾロン, トラニラスト, 柴苓湯の内服にて再狭窄を免れ, 現在も良好な状態を保つている.<BR>口腔咽頭潰瘍治癒後の瘢痕から咽頭狭窄をきたした報告例を検討し, 診断および治療について文献的考察を加えた.

Six patients with malignant melanoma of the nasal cavity were treated at the Department of Otolaryngology, Jichi Medical School, from January 1990 to August, 1995. Their ages ranged from 57 to 75 years old, with a mean age of 67 years. Primary site of the tumor was the turbinates in three patients, the olfactory region in two, and the inferior meatus in one. Histologically, four cases were the amelanotic type, one was the oligomelanotic type and one was the melanotic type. The treatment consisted of surgery, radiotherapy, chemotherapy, hormonal therapy, immunotherapy, or a combination of these treatment. All patients also received surgical treatment. Four patients received combination therapy with radiotherapy and surgery, one received combination therapy with radiotherapy, chemohormonal therapy and surgery, and one received only surgery. Four patients were treated radically, and two patients underwent palliative resection. Irradiation was used as the preoperative therapy in four patients. Combination therapy with radiation and chemohormonal therapy (dacarbazine+nimustine+vincristine sulfate+tamoxif en citrate) was performed on one patient as an adjuvant therapy. The total tumor dose varied between 40 and 48 Gy. Two cases survived for two years after their diagnosis. Two cases died because of local recurrence, and two cases died because of metastasis. The cumulative survival rate among our cases was 40±20% after two years by the Kaplan-Meier method. None of the cases was alive three years after their diagnosis.