超音波内視鏡下生検組織診断およびFDG‐PETが質的診断に有用であった噴門部平滑筋肉腫の1例

Gastric Leiomyoma of the Cardiac Region - Sonopsy through EUS and FDG-PET were Useful for it's Qualitative Diagnosis, Report of a Case

要旨　患者は50歳，女性．無症状で胃の集団検診を目的とした上部消化管X線検査で病変の存在が指摘された．術前の質的診断として，超音波内視鏡および超音波内視鏡下生検組織診断，FDG-PETで悪性腫瘍が示唆され，噴門側胃切除を施行した．腫瘍は4.7×3cmで病理診断はleiomyosarcomaであった．

　A fifty-year-old woman was admitted to our department for more detailed medical evaluation and treatment of a cardiac lesion. X-ray and endoscopic examinations revealed a protruding lesion with a bridging fold on the greater curvature of cardia. EUS disclosed a tumorous lesion, 4×3 cm in diameter, of a high and low mixed echo pattern, adjacent to the mp layer. Sonopsy through EUS showed spindle shaped cells with large and chromatin rich nucleus and high atypia. The surrounding area of the lesion was enhanced by dynamic CT scan, and the Ci/Cp value of FDG-PET was 3.02 which was above the malignant cut off point of 2.0. The preoperative diagnosis of the lesion was a malignant myogenic tumor and operation was performed. The resected specimen showed the size of the lesion was 4.7×3.0 cm in diameter and histologically, leiomyosarcoma with low grade malignancy.