壁外へ発育した胃平滑筋肉腫の1例

Leiomyosarcoma in the Gastric Wall, Report of a Case

要旨　径1.5cmのくびれを持つ,大きさ5.0×4.0×4.5cmの胃壁外発育型の平滑筋肉腫の1例を報告した．患者は69歳，女性．無症状で胃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．この病変の形態・内部変化を把握するには，超音波内視鏡検査が極めて有用であった．しかし，術前の質的診断となると，内視鏡検査，超音波内視鏡検査での腫瘍の形態から内視鏡下での粘膜切開組織生検法は難しく，平滑筋腫との鑑別は困難であった．

　In a 69-year-old asymptomatic woman, gastric fluoroscopy disclosed compression of the gastric body on the side of the greater curvature, suggesting the presence of a tumor in the gastric wall.

　Using further examination by gastrofiberscopy, abdominal CT scan, abdominal angiography and ultrasonic endoscopy, a 4×5 cm tumor, originating from the tunica muscularis and extending out of the gastric wall, was found. The tumor had a constricted part with a diameter of 1.5 cm, and was partially necrotic.

　The removed tumor (5×4×4.5 cm) was histopathologically diagnosed as being gastric leiomyosarcoma.

　In examining the site and morphology of this tumor, ultrasonic endoscopy was most useful.