【口腔】特殊な高分化扁平上皮癌：孔道癌について

Clinicopathological evaluation of carcinoma cuniculatum: a variant of oral squamous cell carcinoma

J Oral Pathol Med. 2012 Apr;41(4):303-8.

Yan Sun, Kayo Kuyama, Arne Burkhardt, Hirotsugu Yamamoto

Abstract
Carcinoma cuniculatum (CC) is a rare neoplasm of oral squamous cell carcinoma (OSCC) and remains a histopathological challenge to pathologists because of its low incidence and unique architecture. Therefore, the purpose of this study was to illustrate the clinicopathological findings and biological behavior about this distinctive lesion. Clinical and follow-up information were retrieved from medical charts, and histopathological analyses were performed. Our series included 15 cases of CC, and the study included seven men and eight women, age 44-92. The tongue and mandible were the most frequently affected sites. There were three lymph node metastasis cases, and three local recurrences; one of the patients died of lung metastasis from oral CC. Histopathologically, the point of differential diagnosis with other subtypes of OSCC included unique, cuniculatum architecture and branching crypts. Because of its well-differentiated status, the prognosis of CC is usually optimistic. However, recurrent cases in our study might have possessed invasive biological characters that were not well controlled by conventional treatment; in one case, a portion of the CC transformed into conventional squamous cell carcinoma (SCC). This might suggest that transformed CC rather than primary CC should be further emphasized.

Free article ではないので、その詳細な内容の紹介ができないが、孔道癌（孔道上皮癌 carcinoma cuniculatum）は非常に高分化な扁平上皮癌の一型であり（組織像は追加文献１を参照）、病理診断が非常に難しい（この点は追加文献２を参照）。一見して囊胞との区別が難しいし、臨床的にも肉芽組織や囊胞のような非腫瘍性組織との鑑別が難しく、質的診断も範囲診断も難しい。まずは、この疾患概念を知っておくことが重要である。

【SANOTIC SUMMARY】
１．孔道癌は高分化で舌や下顎に好発する
　👉診断が難しいので臨床・画像と合わせることが重要（追加文献２）
２．高分化であるが、再発例や転移例、死亡例もある
３．通常型ＳＣＣへの転化例が予後不良である可能性がある

PubMed のリンクはこちら👇

Clinicopathological evaluation of carcinoma cuniculatum: a variant of oral squamous cell carcinoma - PubMed

【追加文献１】実際の組織像などに関しては free の case report のリンクを参照👇

Oral Carcinoma Cuniculatum: A New Entity in the Clinicopathological Spectrum of Oral Squamous Cell Carcinoma

【追加文献２】病理診断が難しいことについての文献（free article ではない）👇

Carcinoma cuniculatum of the oral mucosa: a potentially underdiagnosed entity in the absence of clinical correlation - PubMed

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