診断に難渋した十二指腸GISTの1例 A CASE OF GASTROINTESTINAL STROMAL TUMOR OF THE DUODENUM WITH DIFFICULTY IN DIAGNOSIS

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症例は88歳,男性.平成13年5月頃より腹部腫瘤を自覚,当院を受診した.腹部エコー,腹部CTにて胃大彎側,十二指腸左側,膵体部に接して6cm大の内部構造不均一な血管に富んだ腫瘍を認めた.腹部MRIにて胃十二指腸動脈の分枝が腫瘍の栄養血管であった.可動性良好なことより大網または胃原発の腫瘍を考え,画像上悪性が否定できないため開腹手術を施行した.手術時,腫瘍は十二指腸水平脚より発生し膵被膜に一部浸潤しており,十二指腸部分切除,膵部分切除術を施行した.病理組織学的には十二指腸の固有筋層より発生,免疫染色にてc-kit陽性, CD34陽性, S100蛋白陽性, SMA陰性,神経系への分化を示す低悪性度GISTと診断された.

An 88-year-old man who had been aware of an abdominal tumor since May 2001 was seen at the hospital. Abdominal echography and abdominal CT scan revealed a 6-cm sized tumor with heterogeneous internal structure and plenty with vessels, locating near the greater curvature of the stomach, on the left side of the duodenum, and in contact with the pancreas body. Abdominal magnetic resonance imaging scan demonstrated that a branch of the gastroduodenal artery fed the tumor. Since the tumor was well movable, the tumor arising from the greater omentum or stomach seemed likely. A possibility of malignancy could not be ruled out, and so laparotomy was performed. During surgery, we saw the tumor arising from the transverse part of the duodenum and partially invading the pancreas capsule. A partial resection of the duodenum and a partial pancreatectomy were carried out. Histopathologically the tumor arose from the proper muscle of the duodenum, and was positive for c-kit, CD34 and S100 protein and negative for SMA on immunostainings. The tumor was diagnosed as gastrointestinal stromal tumor (GIST) with a low grade of malignancy showing differentiation to the nervous system.

収録刊行物

  • 日本臨床外科学会雑誌 = The journal of the Japan Surgical Association

    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 65(3), 679-682, 2004-03-25

    Japan Surgical Association

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各種コード

  • NII論文ID(NAID)
    10012865175
  • NII書誌ID(NCID)
    AA11189709
  • 本文言語コード
    JPN
  • 資料種別
    NOT
  • ISSN
    13452843
  • データ提供元
    CJP書誌  J-STAGE 
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