内容紹介
Summary
This case involved a 42-year-old woman who had no remarkable findings in terms of case history and family history. Upper gastrointestinal series performed during a medical examination revealed ulcerative lesions in the anterior wall of the stomach body. Upper gastrointestinal endoscopy was performed, and a submucosal tumor with a maximum diameter of 50 mm accompanied by an ulcerative lesion was found in the anterior wall of the lower part of the stomach. She was diagnosed with a schwannoma based on endoscopic ultrasonography-guided fine needle aspiration, and we received consultation for surgical purpose. Surgery was performed with laparoscopic partial resection of the stomach and lymph nodes in the lesser curvature of the stomach. She was discharged on the 7th day after the surgery. The postoperative pathologic findings showed no nuclear fissure or atypia with a diagnosis of a schwannoma and no lymph node metastasis. Gastric schwannoma is a rare disease that arises from Schwann cells of the Auerbach's plexus of the gastric wall muscularis and comprises 0.1-0.2% of all stomach tumors. Preoperative diagnosis is often extremely difficult, and there are reports of malignancy. Treatments and surgical methods should be carefully considered. Herein, we encountered a case of a resected giant gastric schwannoma by laparoscopic surgery, which is reported with a literature review.
要旨
症例は42歳,女性。既往歴に特記事項はない。今回,検診で施行した上部消化管造影検査で胃体部前壁に潰瘍性病変を指摘された。上部消化管内視鏡検査を施行し,胃体下部前壁に潰瘍病変を伴う最大径50 mmの粘膜下腫瘍を認めた。内視鏡下穿刺吸引細胞診で神経鞘腫の診断となり,手術目的に当科紹介受診となった。手術は,腹腔鏡下胃部分切除術および胃小弯のリンパ節を摘出した。術後経過良好で7日目に退院した。術後病理所見は神経鞘腫の診断で核分裂像や異型性を認めず,リンパ節転移も認めなかった。胃神経鞘腫は胃壁筋層のアウエルバッハ神経叢のシュワン細胞から生じ,全胃腫瘍の0.1～0.2%とまれな疾患である。術前診断が極めて困難な場合が多くまた悪性の報告もあり,治療,手術方式は慎重に検討すべきである。今回,胃原発の巨大神経鞘腫を腹腔鏡下手術で切除した1例を経験したので,若干の文献的考察を加え報告する。
目次
This case involved a 42-year-old woman who had no remarkable findings in terms of case history and family history. Upper gastrointestinal series performed during a medical examination revealed ulcerative lesions in the anterior wall of the stomach body. Upper gastrointestinal endoscopy was performed, and a submucosal tumor with a maximum diameter of 50 mm accompanied by an ulcerative lesion was found in the anterior wall of the lower part of the stomach. She was diagnosed with a schwannoma based on endoscopic ultrasonography-guided fine needle aspiration, and we received consultation for surgical purpose. Surgery was performed with laparoscopic partial resection of the stomach and lymph nodes in the lesser curvature of the stomach. She was discharged on the 7th day after the surgery. The postoperative pathologic findings showed no nuclear fissure or atypia with a diagnosis of a schwannoma and no lymph node metastasis. Gastric schwannoma is a rare disease that arises from Schwann cells of the Auerbach's plexus of the gastric wall muscularis and comprises 0.1-0.2% of all stomach tumors. Preoperative diagnosis is often extremely difficult, and there are reports of malignancy. Treatments and surgical methods should be carefully considered. Herein, we encountered a case of a resected giant gastric schwannoma by laparoscopic surgery, which is reported with a literature review.
要旨
症例は42歳,女性。既往歴に特記事項はない。今回,検診で施行した上部消化管造影検査で胃体部前壁に潰瘍性病変を指摘された。上部消化管内視鏡検査を施行し,胃体下部前壁に潰瘍病変を伴う最大径50 mmの粘膜下腫瘍を認めた。内視鏡下穿刺吸引細胞診で神経鞘腫の診断となり,手術目的に当科紹介受診となった。手術は,腹腔鏡下胃部分切除術および胃小弯のリンパ節を摘出した。術後経過良好で7日目に退院した。術後病理所見は神経鞘腫の診断で核分裂像や異型性を認めず,リンパ節転移も認めなかった。胃神経鞘腫は胃壁筋層のアウエルバッハ神経叢のシュワン細胞から生じ,全胃腫瘍の0.1～0.2%とまれな疾患である。術前診断が極めて困難な場合が多くまた悪性の報告もあり,治療,手術方式は慎重に検討すべきである。今回,胃原発の巨大神経鞘腫を腹腔鏡下手術で切除した1例を経験したので,若干の文献的考察を加え報告する。