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症例は39歳の女性で,近医で卵巣腫瘍を指摘され当院婦人科に紹介となった.CA125の上昇と画像検査で骨盤内に充実性部分を伴う嚢胞性腫瘤が認められたことから左卵巣癌との術前診断で開腹手術が施行された.開腹時トライツ靭帯より約230cmの小腸粘膜下に充実性部分と嚢胞部分からなる腫瘍が認められ,小腸部分切除が施行された.病理組織像では束状に配列する紡錘型細胞が認められ,免疫染色検査でc-KIT陽性のため,小腸gastrointestinal stromal tumor(以下,GIST)と診断された.嚢胞を伴う小腸GISTは比較的まれであり画像診断で卵巣腫瘍との鑑別に難渋した報告が散見される.骨盤内腫瘍において小腸GISTも念頭におき,原発巣を特定する検査を加える必要があると考えられた.自験例を含め,卵巣腫瘍と術前診断され,手術時に小腸GISTと診断された本邦報告9例について若干の文献的考察を加え報告する.
We report a case of gastrointestinal stromal tumor (GIST) with cystic change difficult to distinguish from ovarian tumor. A 39-year-old woman found in ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI) to have a solid, cystic pelvic tumor suspected of being to have ovarian tumor was found in laparotomy to have a solid 8.7-cm cystic tumor apparently arising in the small intestine 230cm rostral to the Treitz ligament, necessitating partial resection of the portion of small intestine containing the tumor. Histopathologically, fascicular spindle-shaped tumor cells were found in the submucosa that were immunohistochemically positive for c-kit, yielding a diagnosis of gastrointestinal stromal tumor of the small intestine. Indications by US, CT, or MRI of an intrapelvic tumor necessitate additional examination for possible GIST of the small intestine. Our case is the tenth reported in Japan to have been diagnosed preoperatively as an ovarian tumor, but shown postoperatively to be GIST of the small intestine.
