遡及的検討で急速発育が確認された胃平滑筋肉腫の1例

Leiomyosarcoma of the Stomach Followed Up Retrospectively, Report of a Case

要旨　患者は64歳，男性．1992年4月の胃X線検査で体上部後壁大彎寄りに23×17mmの粘膜下腫瘍を認めた．超音波内視鏡検査では筋原性腫瘍と診断された．患者は検診の受診歴があり，遡及的検討を行った．1990年4月の胃X線検査では同部位に最大径が10mmの隆起性病変を認め，腫瘍発育速度（doubling time，以下DT）は6.6か月であった．腫瘍の急速な増大により，悪性と診断し胃局所切除術が施行され，組織学的に胃平滑筋肉腫と診断された．筋原性腫瘍の良・悪性の鑑別診断は困難であることが少なくなく，特に本症例のような小さな筋原性腫瘍は外科的切除を含めた臨床的取り扱いが問題となる．このような場合，腫瘍のDTは良・悪性の鑑別診断に有効であると考えられた．

　The patient was a 64-year-old man with leiomyosarcoma of the stomach. The growth rate of the tumor was observed roentgenologically by a review of the findings during a mass survey of the stomach. The last x-ray examination revealed a smooth surface protruding lesion with bridging folds on the posterior wall of the upper gastric body, in April, 1992, and the tumor grew from 1.0 cm to 2.3 cm in diameter during the observation period of two years. The doubling time of the tumor was 6.6 months. Endoscopic ultrasonography demonstrated that the lesion was a myogenic tumor. Local excision was performed on June 16, 1992. Histopathological study of the resected specimen revealed leiomyosarcoma of the stomach.