内容紹介
Summary
Case 1: A 52-year-old man underwent laparoscopic total gastrectomy for gastric cancer. After 2 years, a follow-up computed tomography(CT)scan showed a large, solid 10 cm-sized mass in his left upper abdomen. Under the diagnosis of a suspected mesenchymal tumor, a tumor resection with a partial resection of the upper jejunum and transverse colon was performed. Case 2: A 61-year-old man underwent laparoscopic pylorus-preserving gastrectomy for gastric cancer. After 1.5 years, follow-up CT showed a tumor of 2 cm in diameter near the greater curvature side of the upper stomach. Under the diagnosis of a suspected gastrointestinal stromal tumor(GIST), a laparoscopic partial resection of the stomach was performed. Histologically, spindle-shaped cells without atypia and rich collagen fibers were observed, and the sample was positive for β-catenin by immunostaining in both cases; from this evidence, the patients were diagnosed with desmoid tumors. Desmoid tumors have invasive proliferation characteristics, and treatment requires consideration of the balance between securing a surgical margin and increasing surgical stress.
要旨
腹腔鏡下胃切除術後の定期検査で発見され,手術にて切除し得た腹腔内デスモイド腫瘍の2例を経験したので報告する。症例1: 52歳,男性。胃体部癌に対し腹腔鏡下胃全摘術(Roux-en-Y再建)を施行した。術後2年目のCT検査にて,10cm大の充実性腫瘍を認めた。間葉系腫瘍を疑い,小腸部分切除+横行結腸部分切除にて摘出した。症例2: 61歳,男性。胃体部癌に対し腹腔鏡下幽門輪温存胃切除術を施行した。術後1.5年のCT検査にて,胃体上部大弯側胃壁に2 cm大の腫瘍を認めた。胃GISTを疑い,腹腔鏡下胃部分切除術にて摘出した。病理組織診ではともに錯綜配列をとる紡錘形細胞と豊富な膠原線維を認め,免疫染色の結果を含めデスモイド腫瘍の診断となった。デスモイド腫瘍は浸潤性に増殖する特徴を有しており,外科的マージンの確保と周囲組織の合併切除による侵襲の増加とのバランスを考慮する必要がある。
目次
Case 1: A 52-year-old man underwent laparoscopic total gastrectomy for gastric cancer. After 2 years, a follow-up computed tomography(CT)scan showed a large, solid 10 cm-sized mass in his left upper abdomen. Under the diagnosis of a suspected mesenchymal tumor, a tumor resection with a partial resection of the upper jejunum and transverse colon was performed. Case 2: A 61-year-old man underwent laparoscopic pylorus-preserving gastrectomy for gastric cancer. After 1.5 years, follow-up CT showed a tumor of 2 cm in diameter near the greater curvature side of the upper stomach. Under the diagnosis of a suspected gastrointestinal stromal tumor(GIST), a laparoscopic partial resection of the stomach was performed. Histologically, spindle-shaped cells without atypia and rich collagen fibers were observed, and the sample was positive for β-catenin by immunostaining in both cases; from this evidence, the patients were diagnosed with desmoid tumors. Desmoid tumors have invasive proliferation characteristics, and treatment requires consideration of the balance between securing a surgical margin and increasing surgical stress.
要旨
腹腔鏡下胃切除術後の定期検査で発見され,手術にて切除し得た腹腔内デスモイド腫瘍の2例を経験したので報告する。症例1: 52歳,男性。胃体部癌に対し腹腔鏡下胃全摘術(Roux-en-Y再建)を施行した。術後2年目のCT検査にて,10cm大の充実性腫瘍を認めた。間葉系腫瘍を疑い,小腸部分切除+横行結腸部分切除にて摘出した。症例2: 61歳,男性。胃体部癌に対し腹腔鏡下幽門輪温存胃切除術を施行した。術後1.5年のCT検査にて,胃体上部大弯側胃壁に2 cm大の腫瘍を認めた。胃GISTを疑い,腹腔鏡下胃部分切除術にて摘出した。病理組織診ではともに錯綜配列をとる紡錘形細胞と豊富な膠原線維を認め,免疫染色の結果を含めデスモイド腫瘍の診断となった。デスモイド腫瘍は浸潤性に増殖する特徴を有しており,外科的マージンの確保と周囲組織の合併切除による侵襲の増加とのバランスを考慮する必要がある。