内容紹介
Summary
A 78-year-old woman was referred for exertional dyspnea. Severe anemia(Hb 4.2 g/dL)was detected, and upper endoscopy revealed a giant ulcer at the posterior wall of the gastric body. Computed tomography showed a mass protruding from the gastric wall, suggestive of a submucosal tumor. Although biopsy did not confirm a diagnosis, we performed distal gastrectomy to control the bleeding. The pathological findings and systemic examination confirmed a diagnosis of extramedullary plasmacytoma of the stomach. Plasmacytoma is a tumor of the bone marrow derived from plasma cells that mature from B cells. The frequency of extramedullary plasmacytoma for all plasmacytoma is about 5% and plasmacytoma derived from the stomach occurs in approximately 2% of these cases. Complete resection with lymph node dissection according to the surgical treatment of gastric cancer is recommended. Large tumors, such as that in the present case, may have a poor prognosis; thus, careful follow-up is required for the early detection of recurrence. We report a case of extramedullary plasmacytoma of the stomach with a literature review.
要旨
症例は78歳,女性。歩行時の息苦しさを主訴に受診され,高度貧血(Hb 4.2 g/dL)を認めた。上部消化管内視鏡検査で胃体部後壁に巨大潰瘍を認めた。CT検査では胃壁外突出性の腫瘤性病変を認め,粘膜下腫瘍が疑われた。生検では確定診断が得られなかったが,粘膜下腫瘍切除と出血コントロールを目的に幽門側胃切除術を行った。病理検査と術後全身精査の結果,胃原発髄外性形質細胞腫の診断となった。形質細胞腫はB細胞の最終段階である形質細胞に由来する骨髄の腫瘍であり,骨髄以外に発生する頻度は全体の5%とされ,そのなかでも胃原発のものは約2%とまれである。治療は胃癌に準じたリンパ節郭清を伴う完全切除が基本とされている。本症例のような巨大腫瘍例は予後が悪い可能性があり,慎重な術後観察を要すると考えられる。胃原発形質細胞腫について若干の文献的考察を加えて報告する。
目次
A 78-year-old woman was referred for exertional dyspnea. Severe anemia(Hb 4.2 g/dL)was detected, and upper endoscopy revealed a giant ulcer at the posterior wall of the gastric body. Computed tomography showed a mass protruding from the gastric wall, suggestive of a submucosal tumor. Although biopsy did not confirm a diagnosis, we performed distal gastrectomy to control the bleeding. The pathological findings and systemic examination confirmed a diagnosis of extramedullary plasmacytoma of the stomach. Plasmacytoma is a tumor of the bone marrow derived from plasma cells that mature from B cells. The frequency of extramedullary plasmacytoma for all plasmacytoma is about 5% and plasmacytoma derived from the stomach occurs in approximately 2% of these cases. Complete resection with lymph node dissection according to the surgical treatment of gastric cancer is recommended. Large tumors, such as that in the present case, may have a poor prognosis; thus, careful follow-up is required for the early detection of recurrence. We report a case of extramedullary plasmacytoma of the stomach with a literature review.
要旨
症例は78歳,女性。歩行時の息苦しさを主訴に受診され,高度貧血(Hb 4.2 g/dL)を認めた。上部消化管内視鏡検査で胃体部後壁に巨大潰瘍を認めた。CT検査では胃壁外突出性の腫瘤性病変を認め,粘膜下腫瘍が疑われた。生検では確定診断が得られなかったが,粘膜下腫瘍切除と出血コントロールを目的に幽門側胃切除術を行った。病理検査と術後全身精査の結果,胃原発髄外性形質細胞腫の診断となった。形質細胞腫はB細胞の最終段階である形質細胞に由来する骨髄の腫瘍であり,骨髄以外に発生する頻度は全体の5%とされ,そのなかでも胃原発のものは約2%とまれである。治療は胃癌に準じたリンパ節郭清を伴う完全切除が基本とされている。本症例のような巨大腫瘍例は予後が悪い可能性があり,慎重な術後観察を要すると考えられる。胃原発形質細胞腫について若干の文献的考察を加えて報告する。