腫瘍露出し短期間に形態変化を来したGISTの1例

The Getting Out Tumor Dew GIST which Caused a Form Change in a Short Term, Report of a Case

要旨●患者は30歳代，女性．めまいを主訴に当院を受診し，貧血（Hb 3.0g/dl）を認めた．EGDを施行した胃体下部前壁にbridging foldを伴う大きさ約35mmの隆起性病変を呈していた．隆起の立ち上がりは急峻であり境界明瞭，辺縁は整であった．生検にて紡錘形細胞腫瘍，特にGISTが疑われた．2か月後の内視鏡検査では，頂部に白苔を伴う深い陥凹を有する大きさ20mm程度のSMTへと形態変化を来した．切除標本では固有筋層内に紡錘形細胞から成る腫瘍性病変を認めた．c-kit弱陽性，CD34陽性，DOG1陽性，PDGFRA陽性でGISTと診断した．今回筆者らは，表層に腫瘍が露出し短期間で脱落したまれな胃GISTの1例を経験したので報告する．

　A 30-year-old woman was brought to the hospital due to a chief complaint of dizziness. Based on an examination, the patient was found to be anemic（hemoglobin level of 3.0g/dL）. Upper gastrointestinal tract endoscopy was performed, which revealed a 35mm torose lesion with a bridging fold in the lower region of the anterior wall of the stomach.

　Initially, a steep eminence was observed. However, the boundaries were clear, and the margins were regular. A spindle cell tumor, particularly a GIST（gastrointestinal stromal tumor）, was suspected based on biopsy findings. Two months later, endoscopy was performed, which revealed structural changes in the tumor, i.e., a 20mm submucosal tumor with the deep dip with the fur in the cupular part.

　Biopsy of the specimen from the muscularis propria revealed that the neoplastic lesion comprised spindle cells. The tumor was slightly positive for c-kit and positive for CD34, DOG-1, and PDGFRA. Thus, GIST diagnosis was confirmed. Here, we report a rare case of GIST, in which the tumor was evaluated while it underwent structural changes in a short period of time.