内容紹介
A Case Survived Long Period after Repeated Operation against the Small Intestinal GIST with Perforation
Summary
A patient was 60-year-old man. In March 2011, the small bowel tumor with perforation was found and the partial resection of small intestine was urgently performed. KIT of resected specimen was positive. Then, diagnosis as GIST was defined. Oral administration of imatinib was started, but it was finished in 5 months because of development of the systemic edema. In February 2013, the abdominal CT revealed a tumor of 20 cm in size in the pelvis. Upon laparotomy, we detected the GIST recurrence generated at the region of small intestine anastomosis where manipulated previously, then resected all of tumor and partially small intestine. Afterward, we diagnosed as a recurrence of GIST. In March 2014, the abdominal CT found 4 cm sized mesenteric tumor and 2 cm sized abdominal wall tumor. The laparotomy was performed and we found 5 disseminated nodules intraperitoneally. We confirmed that all of these disseminated nodules were successfully removed. We defined them as re-recurrence of GIST. Six years and 5 months have elapsed since the first operation was performed, but there is no sign of three times recurrence.
要旨
症例は60歳,男性。2011年3月小腸腫瘍穿孔・汎発性腹膜炎の診断で緊急手術を施行した。小腸部分切除を行い,KIT陽性でgastrointestinal stromal tumor(GIST)の診断となった。腫瘍径6 cm,核分裂像4/50HPFで中リスクであった。イマチニブ内服を開始したが,浮腫のため5か月で内服終了となった。2013年2月腹部造影CT検査で腹腔内に20 cm大の腫瘤を認めた。再手術を行い,前回手術の小腸吻合部より腫瘍が発生しており,小腸を部分切除し腫瘍を摘出した。GIST再発の診断であった。術後イマチニブは内服せずに経過観察した。2014年3月腹部造影CT検査で4 cm大の腹腔内腫瘍と2 cm大の腹壁腫瘍を認めた。再々手術を行い,S状結腸間膜,小腸間膜,臍下部腹壁,後腹膜,ダグラス窩に播種結節を認め,すべて切除した。GIST再々発の診断であった。最初の手術から6年5か月経過しているが,再々手術の後再発の徴候はない。まれな小腸GIST穿孔後の術後再発に対し繰り返し手術を行うことにより,長期生存を得ている症例を経験したので報告する。
目次
Summary
A patient was 60-year-old man. In March 2011, the small bowel tumor with perforation was found and the partial resection of small intestine was urgently performed. KIT of resected specimen was positive. Then, diagnosis as GIST was defined. Oral administration of imatinib was started, but it was finished in 5 months because of development of the systemic edema. In February 2013, the abdominal CT revealed a tumor of 20 cm in size in the pelvis. Upon laparotomy, we detected the GIST recurrence generated at the region of small intestine anastomosis where manipulated previously, then resected all of tumor and partially small intestine. Afterward, we diagnosed as a recurrence of GIST. In March 2014, the abdominal CT found 4 cm sized mesenteric tumor and 2 cm sized abdominal wall tumor. The laparotomy was performed and we found 5 disseminated nodules intraperitoneally. We confirmed that all of these disseminated nodules were successfully removed. We defined them as re-recurrence of GIST. Six years and 5 months have elapsed since the first operation was performed, but there is no sign of three times recurrence.
要旨
症例は60歳,男性。2011年3月小腸腫瘍穿孔・汎発性腹膜炎の診断で緊急手術を施行した。小腸部分切除を行い,KIT陽性でgastrointestinal stromal tumor(GIST)の診断となった。腫瘍径6 cm,核分裂像4/50HPFで中リスクであった。イマチニブ内服を開始したが,浮腫のため5か月で内服終了となった。2013年2月腹部造影CT検査で腹腔内に20 cm大の腫瘤を認めた。再手術を行い,前回手術の小腸吻合部より腫瘍が発生しており,小腸を部分切除し腫瘍を摘出した。GIST再発の診断であった。術後イマチニブは内服せずに経過観察した。2014年3月腹部造影CT検査で4 cm大の腹腔内腫瘍と2 cm大の腹壁腫瘍を認めた。再々手術を行い,S状結腸間膜,小腸間膜,臍下部腹壁,後腹膜,ダグラス窩に播種結節を認め,すべて切除した。GIST再々発の診断であった。最初の手術から6年5か月経過しているが,再々手術の後再発の徴候はない。まれな小腸GIST穿孔後の術後再発に対し繰り返し手術を行うことにより,長期生存を得ている症例を経験したので報告する。