早期胃癌に併発した仙骨前面骨髄脂肪腫の1例  [in Japanese] Presacral Myelolipoma with Early Gastric Cancer  [in Japanese]

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Abstract

<p> 早期胃癌に仙骨前面骨髄脂肪腫を併発した症例を経験した.胃癌の治療前検査中,偶然仙骨前面に4 cm径の腫瘤が指摘され,画像上脂肪肉腫が疑われた.同腫瘤は病理診断を行う目的で広範切除が施行された.病理所見は正常骨髄組織が脂肪組織内に混在する腫瘍で,悪性所見はなく,骨髄脂肪腫と診断された.仙骨前面腫瘤の確定診断後,胃癌の根治切除が施行された.仙骨前面骨髄脂肪腫は,まれな疾患であるが,脂肪成分を含有する後腹膜腫瘍で発生頻度が比較的高い脂肪肉腫との鑑別が重要である.しかし,この鑑別診断には従来のCTあるいはMRIでは限界があり,検体採取による病理組織学的診断が重要である.本症例では治療前検査としてPET-CTが施行され,同腫瘤に最高standard uptake value値1.61の異常集積が見られた.これは,これまで報告されている脂肪肉腫のそれよりも低値であった.このPET-CTは,仙骨前面の脂肪含有腫瘍の鑑別の一助となる可能性が示唆された.</p>

<p>We treated a patient with early gastric cancer with a very rare presacral myelolipoma. This rare lesion was found incidentally as a fat containing 4 cm tumor in the presacral space during preoperative examinations for the gastric cancer. This lesion was considered suspicious as a liposarcoma according to CT and MRI images. Therefore the presacral tumor was widely excised in order to obtain tumor specimens and diagnose it histologically. It was not difficult to excise it, because it was encapsulated and not invasive to surrounding tissues. The presacral tumor was finally diagnosed as myelolipoma based on pathological findings which were composed of mature adipose tissue and hematopoietic elements. This diagnosis of the tumor allowed us to perform a complete resection for the gastric cancer. Presacral myelolipoma is a benign but very rare fat-containing tumor, which should be discriminated from the liposarcoma occasionally arising in the retroperitoneum. However, it is too difficult to discriminate between these two lesions under only conventional CT or MRI imaging and the difficulty led us to obtain tumor specimens by fine needle aspiration biopsy or tumor resection. In this case, a PET-CT image was taken as a pretreatment examination. We suggest that this image can be effective for differential diagnosis, because maximal standardized uptake value (SUV) in this case was 1.61 and lower than that in liposarcoma cases previously reported. This new device is promising and may help to discriminate between presacral fat containing tumors.</p>

Journal

  • The Japanese Journal of Gastroenterological Surgery

    The Japanese Journal of Gastroenterological Surgery 50(2), 158-165, 2017

    The Japanese Society of Gastroenterological Surgery

Codes

  • NII Article ID (NAID)
    130005242979
  • Text Lang
    JPN
  • ISSN
    0386-9768
  • Data Source
    J-STAGE 
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