A case of double cancer in oronasopharyngeal region: carcinoma in situ of the tongue and nasopharyngeal carcinoma

A 55-year-old woman was refered to our clinic in August 1989. Large erythroplakia was recognized in the left edge of the tongue. The lesion was surgically excised and pathologically diagnosed as carcinoma in situ. The disease did not recur. About two years later large mass developed in the left upper neck. Though the neck mass was assumed to be a metastasis from unidentified primary lesion and examination including consultation with otolaryngologist was performed, no carcinoma was detected in the other sites. So the neck lesion was extirpated and pathologically diagnosed as moderately differentiated squamous cell carcinoma. After five months paresthesia arose in the left cheek. The cranial CT findings suggested nasopharyngeal carcinoma (NPC). Moderately to poorly differentiated squamous cell carcinoma was found by blind biopsy by otolaryngologist. At this time origin of neck nodes proved to be NPC. Neither NPC nor neck mass lesion were controlled and she died in July 1992.舌上皮内癌と上咽頭癌が異時性に重複した1例を報告した｡症例は55歳の女性で1989年4月当科を初診した｡初診時,左舌側縁に広範な紅板症を認めた｡生検で高度上皮異形成と診断し,外科的に切除した。摘出物の一部に,より強い細胞異型,異常核分裂像,細胞極性の乱れがみられ,最終的に上皮内癌と診断した。再発なく経過したが,約2年後左上頸部に巨大な腫瘤が出現した。他の原発病変からの転移と考え,耳鼻科医との対診を含めた精査を行ったが,他に異常は認めなかった｡そこで頸部腫瘤を摘出し,中等度分化型の扁平上皮癌の診断を得た｡その5か月後左頬部に知覚異常が出現した｡頭部CT所見から上咽頭癌が疑われ,耳鼻科医による生検で中等度～低分化型の上咽頭扇平上皮癌の診断を得た。この時点で頸部リンパ節転移の原発巣は上咽頭癌であることが判明した。放射線治療を行ったが,上咽頭癌,頸部リンパ節とも制御できず1992年7月死の転帰をとった