穿孔性腹膜炎にて発症した小腸GISTの1例 [in Japanese] A CASE OF GASTROINTESTINAL STROMAL TUMOR (GIST) OF THE SMALL INTESTINE PRESENTED WITH PERFORATIVE PERITONITIS [in Japanese]
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症例は59歳の男性で,突然の下腹部痛を主訴に来院.精査にて穿孔性腹膜炎の診断のもとに緊急開腹術を施行.回腸末端より約40cm口側の小腸に径10cm大の腫瘤を認め, S状結腸に浸潤しつつ穿孔しており,回腸部分切除, S状結腸切除術および人工肛門造設術を施行した.病理組織学的所見で紡錘状の腫瘍細胞の増殖がみられ,免疫染色でc-kit, CD34陽性, α-SMA, S-100蛋白陰性であったためgastrointestinal stromal tumor, uncommitted typeと診断した.現在,メシル酸イマチニブを服用し,外来にて約2年間の経過観察中であるが現在のところ再発は認められていない.
A 59-year-old man was admitted to our hospital with severe lower abdominal pain. Under the diagnosis of perforative peritonitis, emergency laparotomy was performed. There was a tumor (10cm in diameter) of the ileum and invasion of the sigmoid colon, which already was perforated. We performed a partial resection of the ileum, sigmoidectomy and colostomy. Histopathological findings showed that the tumor was composed of spindle cell proliferation. Because tumor cells were positive for c-kit and CD34, and negative for α-smooth muscle actin and S-100 protein immunohistochemically, we diagnosed the tumor as GIST of the small intestine, uncommitted type. The patient was treated with imatinib mesylate as an outpatient.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 67(12), 2869-2873, 2006-12-25
Japan Surgical Association