特異な形態を呈した十二指腸GISTの1例

Duodenal GIST, Presenting with an Anomalous Form, Report of a Case

要旨●患者は70歳代，男性．発熱を主訴に，多発性肝腫瘍と十二指腸腫瘍の精査目的で当院へ入院となった．十二指腸球部後面に3.5cm大の粘膜下腫瘍様の隆起を認め，12mm大の辺縁がsharpな深掘れ潰瘍，腫瘍の露出した結節など，多彩な潰瘍形成と結節を伴う特異な肉眼形態を呈していた．また，腫瘍の管外発育を示唆する周囲の壁外性圧排像もみられた．生検病理組織にてGISTと診断され，十二指腸GISTの多発性肝転移，肝・膵直接浸潤の状態であり，イマチニブ（400mg/day）にて治療を行った．

　A 70s male with fever was admitted to our hospital for further investigation of multiple hepatic masses and duodenal tumors. The posterior wall of the duodenal bulb had a 3.5cm submucosal tumor-like mass, with a sharp 12mm periphery, deep isolated ulcers, and exposed tumor nodes in esophagogastroduodenoscopy. An anomalous gross morphology accompanied by a multihued ulceration and node was observed. The surroundings of the mass seemed compressed, suggesting an extraintestinal growth of the tumor. On the histopathological analysis of the biopsied tissue, GIST（gastrointestinal stromal tumor）was diagnosed. Multiple hepatic metastases of duodenal GISTs were observed, with direct invasion of the liver and pancreas. Thus, treatment with imatinib（400mg/day）was initiated.