十二指腸原発類上皮平滑筋肉腫の1例

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  • A CASE REPORT OF EPIDERMOID LEIOMYOSARCOMA OF THE DUODENUM

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A 69-year-old man was admitted to the hospital because of lower abdominal pain and constipation. Handgrip-sized mass was palpable at the left upper quadrant of the abdomen. CT scan of the abdomen revealed about 16×10cm solid tumor at the same region. After some other examinations small intestinal tumor derived from non-epithelial lesion was suspected. Upon laparotomy tumor grew extramurally from the third portion of duodenum and the peritoneum showed several disseminated nodules. A partial resection of the lesion with reconstruction by side to side anastomosis between the defect and jejunum was carried out. Postoperative histopathological findings on H-E staining revealed compact proliferation of round or spindle shaped cells with epitheloid arrangement. Immunohistochemiccal analysis showed positive staining for vimentin, and negative for smooth muscle actin, CD 34 antigen, S-100 protein. From these findings, this tumor was diagnosed as epitheloid leiomyosarcoma of the duodenum. This patient was predicted malignant because of tumor size and high miotic ratio (more than 1 mitose per one HPF). He died from the disease 18 months after the operation.<br> Epidermoid leiomyosarcoma of the duodenum is so rare that only 17 cases including ours have been reported in the Japanese literature as far as we could review.

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