術前に診断しえた直腸平滑筋肉腫の１治験例

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  • A case report of a preoperatively diagnosed leiomyosarcoma of the rectum.

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A 67-year-old man was admitted to our department with the chief complaint of discomfort in the anus and tenesmus. Abdominoperineal resection of the rectum was performed, and a diagnosis of leiomyosarcoma was made preoperatively. The tumor was 12×6×6 cm in size, and its cross section showed a gray-white tumor with central necrosis. Microscopically, it consisted of spindle, oval-shaped cells in interlacing fascicles. The mitotic rate was 4.2 mitotic figures per 10 high power fields. In Japan, only 134 cases of leiomyosarcoma of the rectum had been reported up to 1989. Among these, only 43 (31.9%) were diagnosed preoperatively. Radical resection was performed in 102 (75.6%) cases and local resection in 25 (18.5%). Recently, it was stated that the prognosis of leiomyosarcoma is influenced by histopathological features and operative methods. In conclusion, it is important to diagnose this disease not only by microscopic examination of the biopsy specimen but also by medical imaging such as computed tomography, ultrasonography, and angiography. Radical resection should be performed, once the disease is diagnosed.

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