内容紹介
Summary
Multiple sporadic gastrointestinal stromal tumor(GIST)are rare, except for those restricted to von Recklinghausen disease or hereditary conditions. We reported a case of a gastric GIST resected 9 years after the resection of a duodenal GIST. The patient was a 58-year-old male who had been followed-up with computed tomography scans after pancreatoduodenectomy for a duodenal GIST when he was 49-years-old. The patient was admitted to our hospital for anemia examination. A CT scan detected a tumor in the stomach, with a diameter of over 10 cm, and necrosis. Esophagogastroduodenoscopy revealed the presence of a delle on the gastric SMT. Due to suspected invasion of the spleen and left diaphragm by the tumor, we performed subtotal gastrectomy with splenectomy and left diaphragm segmental resection. In the pathological diagnosis, the tumor was diagnosed as a gastric GIST, because the cell type of the tumor was spindle and tested positive for c-kit. Based on the tumor size and mitotic count, the patient was diagnosed with high-risk GIST by the modified-Fletcher classification, and imatinib 400 mg/day was administered. There have been no signs of recurrence for 2 years since the operation.
要旨
gastrointestinal stromal tumor(GIST)は単発性に発生することがほとんどで,von Recklinghausen病や遺伝子疾患以外での多発例はまれである。われわれは,十二指腸GIST術後9年後に発生した胃GISTを経験した。症例は58歳,男性。49歳で十二指腸GISTに対して膵頭十二指腸切除術を施行され,CTで経過フォローをされていた。患者は貧血の精査目的に当院へ入院となり,CTにて胃に径10 cm以上の壊死を伴う腫瘤を認めた。上部消化管内視鏡検査では胃のSMTにdelleを認めた。腫瘤は脾臓や左横隔膜への浸潤が疑われたため,胃局所切除術,脾臓摘出術,左横隔膜部分切除術を施行した。病理診断では,異型紡錘形細胞が密に増生し,免疫染色でKIT陽性であったため,胃GISTと診断した。腫瘍径,核分裂像数からmodified-Fletcher分類で高リスク群のGISTと診断し,メシル酸イマチニブ400 mg/日の投与を開始した。術後2年経過した現在,明らかな再発は認めていない。
目次
Multiple sporadic gastrointestinal stromal tumor(GIST)are rare, except for those restricted to von Recklinghausen disease or hereditary conditions. We reported a case of a gastric GIST resected 9 years after the resection of a duodenal GIST. The patient was a 58-year-old male who had been followed-up with computed tomography scans after pancreatoduodenectomy for a duodenal GIST when he was 49-years-old. The patient was admitted to our hospital for anemia examination. A CT scan detected a tumor in the stomach, with a diameter of over 10 cm, and necrosis. Esophagogastroduodenoscopy revealed the presence of a delle on the gastric SMT. Due to suspected invasion of the spleen and left diaphragm by the tumor, we performed subtotal gastrectomy with splenectomy and left diaphragm segmental resection. In the pathological diagnosis, the tumor was diagnosed as a gastric GIST, because the cell type of the tumor was spindle and tested positive for c-kit. Based on the tumor size and mitotic count, the patient was diagnosed with high-risk GIST by the modified-Fletcher classification, and imatinib 400 mg/day was administered. There have been no signs of recurrence for 2 years since the operation.
要旨
gastrointestinal stromal tumor(GIST)は単発性に発生することがほとんどで,von Recklinghausen病や遺伝子疾患以外での多発例はまれである。われわれは,十二指腸GIST術後9年後に発生した胃GISTを経験した。症例は58歳,男性。49歳で十二指腸GISTに対して膵頭十二指腸切除術を施行され,CTで経過フォローをされていた。患者は貧血の精査目的に当院へ入院となり,CTにて胃に径10 cm以上の壊死を伴う腫瘤を認めた。上部消化管内視鏡検査では胃のSMTにdelleを認めた。腫瘤は脾臓や左横隔膜への浸潤が疑われたため,胃局所切除術,脾臓摘出術,左横隔膜部分切除術を施行した。病理診断では,異型紡錘形細胞が密に増生し,免疫染色でKIT陽性であったため,胃GISTと診断した。腫瘍径,核分裂像数からmodified-Fletcher分類で高リスク群のGISTと診断し,メシル酸イマチニブ400 mg/日の投与を開始した。術後2年経過した現在,明らかな再発は認めていない。