成人腸回転異常症を伴った巨大胃gastrointestinal stromal tumorの1例  [in Japanese] A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE STOMACH WITH MIDGUT NONROTATION IN AN ADULT  [in Japanese]

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Abstract

症例は71歳,男性.左腹部腫瘤を自覚したため近医受診.左季肋部に腫瘤病変を認め当院紹介となった.精査の結果,腸回転異常症を伴う胃巨大粘膜下腫瘍の診断にて手術を施行した.開腹すると腸回転異常症(non-rotation type)が存在した.腫瘍は胃原発であったため幽門側胃切除術を施行した.再建はBillroth I法とし,腸回転異常に対しては予防的虫垂切除のみ施行した.摘出標本は最大径18cmの巨大な軟性の腫瘍で,病理組織学的に多角形ないし短紡錘形の大型細胞が蜜に増生していた.免疫組織染色ではCD34およびvimentinが陽性でありGIS Tuncommited typeと診断した.成人の腸回転異常症はそれ自体が稀な疾患であり,比較的新しい疾患概念であるGISTとの併存は極めて稀である.腸回転異常症は併存病変の外科的治療を困難にする可能性があり,術前診断の際に念頭に置く必要があると考えられた.

A 71-year-old man was admitted to the hospital because of a left abdominal mass. With close examination, a giant submucosal tumor of the stomach with midgut nonrotation was diagnosed. At surgery, a tumor was present in the stomach and the entire small intestine occupied the half of the abdominal cavity indicating midgut nonrotation. We performed a Billroth I gastrectomy and a prophylactic appendectomy. The resected specimen showed an elastic soft tumor with the maximum diameter of 18cm. A histopathological examination revealed a lot of large spindle cells. Immunohistologically, the tumor was positive for CD34 and vimentin, gastrointestinal stromal tumor (GIST) umcommited type of the stomach was definitely diagnosed. Midgut nonrotation in an adult itself is rare, especially the association of the disease with GIST that is a relatively new concept like in this case. Midgut nonrotation can make a surgical therapy for the associated disease a hard work that must be kept in mind in making diagnosis before operation.

Journal

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

    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 63(4), 895-899, 2002-04-25

    Japan Surgical Association

References:  16

Cited by:  2

Codes

  • NII Article ID (NAID)
    10008618873
  • NII NACSIS-CAT ID (NCID)
    AA11189709
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13452843
  • Data Source
    CJP  CJPref  J-STAGE 
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