PET-CTが診断に有用であった小腸腫瘍の1例

Small-bowel Tumor for which PET-CT was Useful for Diagnosis, Report of a Case

要旨●患者は60歳代，女性．検診で便潜血陽性，貧血を指摘されたため，近医でEGD，大腸内視鏡検査を施行されたが異常所見を認めなかった．小腸精査目的に当科へ紹介され受診となった．造影CTでは，回腸末端に壁肥厚が疑われたが，高度肥満症による画質不良のため断定できなかった．PET-CTでは，回腸末端にSUVmax19.5と異常集積を認め，腫瘍性病変が疑われた．経肛門的ダブルバルーン内視鏡検査では，回腸末端に3/4周性の周堤を伴う不整な潰瘍性病変を認めた．生検にて中分化管状腺癌を認め，原発性小腸癌と診断し外科的切除を施行した．

　A 60s woman with a positive fecal occult blood test and anemia underwent esophagogastroduodenoscopy and colonoscopy ; however, these examinations revealed no abnormal findings. The patient was referred to our department for a small bowel examination. Contrast-enhanced computed tomography revealed an undetermined wall thickening at the terminal ileum, which may be attributable to poor image quality caused by severe obesity. Positron emission tomography with computed tomography revealed an abnormal accumulation of a maximum standard unit value of 19.5 at the terminal ileum, which indicated a neoplastic lesion. Retrograde double-balloon endoscopy showed a 3/4-circumference irregular ulcerative lesion at the terminal ileum. A moderately differentiated tubular adenocarcinoma was detected in the biopsy specimen, the patient was diagnosed with primary small bowel cancer, and surgical resection was performed.