内容紹介
Summary
An 83-year-old woman was hospitalized with abdominal discomfort. Abdominal computed tomography(CT)revealed a huge tumor(size, 15 cm)in the gastric body. Based on the findings of endoscopic ultrasonography-guided fine-needle aspiration, she was diagnosed with gastrointestinal stromal tumor(GIST). Invasion of the surrounding viscera and distant metastasis were not observed; however, owing to the tumor size(>10 cm), we initiated neoadjuvant chemotherapy with imatinib. CT performed a month after chemotherapy revealed tumor shrinkage, and CT repeated 6 months after the second CT revealed tumor shrinkage to 8 cm. The patient showed a partial response to chemotherapy. She was deemed suitable to undergo laparoscopic radical resection and subsequently underwent laparoscopic partial gastric resection. Histopathological examination of the resected specimen(measuring 10 cm)revealed hyaline degeneration in most tumor cells and positive c-kit expression in only some proportion of tumor cells. Based on histopathological evaluation, the tumor was diagnosed as Grade 2b. The patient showed an uneventful postoperative course. After discharge, she received imatinib as adjuvant chemotherapy and is progressing well without recurrence. Taken together, we reported the case of a huge gastric GIST in a patient who showed significant tumor shrinkage following preoperative neoadjuvant chemotherapy and successfully underwent laparoscopic radical resection.
要旨
症例は83歳,女性。 腹部違和感を主訴に前医を受診した。 腹部造影CTで胃体部に15 cm大の巨大腫瘤を認め,EUS-FNAでgastrointestinal stromal tumor(GIST)と診断された。他臓器への浸潤,遠隔転移を認めないものの10 cmを超える巨大腫瘍であるため,イマチニブによる術前化学療法の方針となった。投与1か月後にCTで腫瘍は縮小傾向を示し,6か月後には最大径8 cmへさらに縮小を認め,効果判定はPRと判断した。6か月投与時点で腹腔鏡下での根治切除は可能と判断し,腹腔鏡下胃局所切除を施行した。切除標本は最大径10 cmであり,病理組織学的所見では腫瘍の大部分が硝子化変性を伴っており,一部c-kit陽性のGIST細胞の残存を確認するのみで,組織学的効果判定はGrade 2bと判断した。術後合併症なく経過し,退院後,術後補助化学療法としてイマチニブ内服を開始し,現在無再発で経過中である。今回,巨大胃GISTに対して術前化学療法後に著明な腫瘍縮小効果を認め,腹腔鏡下根治切除を施行し得た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
An 83-year-old woman was hospitalized with abdominal discomfort. Abdominal computed tomography(CT)revealed a huge tumor(size, 15 cm)in the gastric body. Based on the findings of endoscopic ultrasonography-guided fine-needle aspiration, she was diagnosed with gastrointestinal stromal tumor(GIST). Invasion of the surrounding viscera and distant metastasis were not observed; however, owing to the tumor size(>10 cm), we initiated neoadjuvant chemotherapy with imatinib. CT performed a month after chemotherapy revealed tumor shrinkage, and CT repeated 6 months after the second CT revealed tumor shrinkage to 8 cm. The patient showed a partial response to chemotherapy. She was deemed suitable to undergo laparoscopic radical resection and subsequently underwent laparoscopic partial gastric resection. Histopathological examination of the resected specimen(measuring 10 cm)revealed hyaline degeneration in most tumor cells and positive c-kit expression in only some proportion of tumor cells. Based on histopathological evaluation, the tumor was diagnosed as Grade 2b. The patient showed an uneventful postoperative course. After discharge, she received imatinib as adjuvant chemotherapy and is progressing well without recurrence. Taken together, we reported the case of a huge gastric GIST in a patient who showed significant tumor shrinkage following preoperative neoadjuvant chemotherapy and successfully underwent laparoscopic radical resection.
要旨
症例は83歳,女性。 腹部違和感を主訴に前医を受診した。 腹部造影CTで胃体部に15 cm大の巨大腫瘤を認め,EUS-FNAでgastrointestinal stromal tumor(GIST)と診断された。他臓器への浸潤,遠隔転移を認めないものの10 cmを超える巨大腫瘍であるため,イマチニブによる術前化学療法の方針となった。投与1か月後にCTで腫瘍は縮小傾向を示し,6か月後には最大径8 cmへさらに縮小を認め,効果判定はPRと判断した。6か月投与時点で腹腔鏡下での根治切除は可能と判断し,腹腔鏡下胃局所切除を施行した。切除標本は最大径10 cmであり,病理組織学的所見では腫瘍の大部分が硝子化変性を伴っており,一部c-kit陽性のGIST細胞の残存を確認するのみで,組織学的効果判定はGrade 2bと判断した。術後合併症なく経過し,退院後,術後補助化学療法としてイマチニブ内服を開始し,現在無再発で経過中である。今回,巨大胃GISTに対して術前化学療法後に著明な腫瘍縮小効果を認め,腹腔鏡下根治切除を施行し得た1例を経験したので,若干の文献的考察を加え報告する。