巨大な回腸平滑筋肉腫の1例

A Case of a Huge Leiomyosarcoma of the Ileum

　小腸平滑筋肉腫は欧米および，わが国でも，近年かなりの報告例が見られるようになったが，なお比較的まれな疾患である．教室では，さきに，十二指腸平滑肉腫3例について報告したが¹⁾²⁾，最近著者らは，回腸に原発した巨大な平滑筋肉腫1例を治験したので報告する．

　Of malignant neoplasms originating from the small intestine carcinoma accounts for 40 to 50 per cent, carcinoid for 15 to 20 per cent and leiomyosarcoma for 13 to 14 per cent. As is evident from these figures, leiomyosarcoma is a relatively rare malignant growth in the small intestine. In this paper is reported a case of it, very large and originating from the ileum.

　The patient, a 23-year-old male student, had since five months before diarrhoea 3 to 8 times a day in addition to loss of appetite. Gradually the lower abdomen became distended. Since two months before he noticed a tumor there the size of a man's fist. He was first treated medically and then referred to our Department with a diagnosis of retroperitoneal tumor. Barium enema examination after admission revealed that the upper portion of the rectum and sigmoid were pushed aside to the right, upwards and posteriorly, resulting in a stricture. Vesicography also disclosed the bladder highly pressed from upwards and the posterior side. Superior mesenteric arteriography showed hypervascularity and tumor stain in an area probably corresponding to that of the terminal part of the ileum. Inferior mesenteric arteriography revealed tumor vessels and dilatation of the sigmoidal artery in a site corresponding to that of the tumor. Surgical operation was done under a tentative diagnosis of sarcoma of the sigmoid. The tumor, with nodular surface and the size of a child's head, adhered to the sigmoid. Adhesion was also seen between the uppermost pole of the tumor and the ileum 30 cm oral from its terminal end. Other viscera were free from abnormality. The resected specimen, measuring 17.0 by 14.5 by 7.0 cm, weighed 1,150 gram. Histological study of the adhered segment between the intestine and the tumor, which proved to be leiomyosarcoma, disclosed that the neoplasm had arisen not from the sigmoid but from the ileum. Nine months after the operation, he was placed under medical management because of metastasis to the subcutaneous tissue of the left thigh and to the liver, and died sixteen months postoperatively.