2カ所に腸重積を合併した多発小腸平滑筋肉腫の1例  [in Japanese] A CASE OF DOUBLE LEIOMYOSARCOMA OF THE SMALL INTESTINE COMBINED WITH SIMULTANEOUS INTUSSUSCEPTION  [in Japanese]

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Abstract

症例は80歳,女性.腹部膨満感,腹痛,食欲不振,嘔吐を主訴に当院に紹介入院となった.腹部は膨隆しイレウスの状態であった.腹部CTにて小腸重積症が存在し,右腋窩リンパ節転移および右肺転移(疑診)を伴っていることより,小腸平滑筋肉腫を疑い10日目に開腹術を行った. Treitz靱帯より20cmと80cmの2カ所に母指頭大および超鶏卵大の腫瘍が存在し,同時に腸重積を合併していた.それぞれ腫瘍を含めて小腸部分切除術を行った.病理組織学的検査の結果は平滑筋肉腫であった.しかし術後11日目に頸椎転移が判明し, 17日目に心肺不全を合併し37日目に死亡退院となった.多発した小腸平滑筋肉腫病変が同時に腸重積を合併した例は自験例を含めて3例報告されているが,いずれも病理組織学的に悪性度が高く,術後早期に遠隔転移をきたして急激な転帰をとるという共通点が認められた.

An 80-year-old woman admitted for abdominal fullness with pain, appetite loss, and vomiting was found to have a distended abdomen, suggesting small bowel obstruction. Abdominal computed tomography showed intussusception of the small intestine possibly caused by leiomyosarcoma because right axillar lymph node and lung metastasis were also found preoperatively. At laparotomy on day 10, a thumb-sized tumor was found 20cm distal from Treitz's ligament and, an egg-sized tumor 80cm distal. These were combined with simultaneous intussusception of the small intestine. We partially resected each affected jejunum. Histopathological findings showed leiomyosarcoma of the small intestine. The patient suddenly underwent cardiothoracic failure on postoperative day (POD) 17, possibly due to cervical vertebral metastasis found on POD 11. She died on POD 37. Only 3 case reports of double small intestinal leiomyosarcoma combined with simultaneous intussusception were found in the literature, including ours. All had similar high-grade malignancy in pathology and a rapid, unfavorable course with distant metastasis in the early postoperative phase.

Journal

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(3), 627-631, 2002-03-25

    Japan Surgical Association

References:  20

Codes

  • NII Article ID (NAID)
    10008617020
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    NOT
  • ISSN
    13452843
  • Data Source
    CJP  J-STAGE 
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