小腸二重造影法により術前に正診しえた空腸の平滑筋肉腫の1例

Leiomyosarcoma Diagnosed by the Double Contrast Radiograph of the Jejunum

　原因不明の下血を頻回に認めた，患者に対し，経口小腸造影で病変を発見し，経ゾンデ法による小腸二重造影法により，質的診断を下しえた空腸の平滑筋肉腫例を経験したので報告する．

　A 47-year-old man, who had a history of tarry stools two or three times every year since 1974, was admitted to the National Cancer Center Hospital complaining of massive melena in January 1978. Physical examination on admission revealed no abnormalities other than slight anemia. Neither tumor nor another abnormal mass were palpated because of distended abdomen. Routine laboratory finding, showed hemoglobin 9.6g/dl with 29.4 per cent hematocrit and 404×10⁴red blood cells. Stool guaiac test was three positive. Neither x-ray examination of the upper and lower alimentary tract nor endoscory disclosed any abnormalities. However, barium meal examination of the small intestine showed a V shaped configuration in the jejunum. Double contrast radiograph of the small intestine revealed a prominant tumor shadow with irregular shallow ulceration at the base of V shaped deformity. Selective superior mesenteric angiogram disclosed an extraluminal hypervascular tumor with early venos drainage.

　With the preoperative diagnosis of leiomyosarcoma, operation was performed. A nodular firm tumor measuring 7×6.5cm in size was found in the middle portion of the jejunum. The bulk of the mass was located at the antimesenteric side and only a small portion of tumor was situated in the jejunal wall with involvement of the overlying mucosa, resulting in mucosal ulceration measuring 9×7mm. There was no evidence of metastasis in the liver and mesenteric lymph node. The cut surface was grey to yellow in color and some cystic or necrotic areas with hemorrhage and degeneration were found in the central part of the tumor. Microscopically, the tumor was composed of interlacing bundles or whorls of spindle cells with pleomorphism, hyperchromatic nuclei, and one or two mitotic findings per high power field. The diagnosis of leiomyosarcoma was confirmed histologitally. The postoperative course was uneventful and the patient was discharged with improved general condition.