腹腔鏡下摘脾術を施行した脾Castleman病の1例

Laparoscopic splenectomy for Castleman's disease arising from the spleen : a case report

極めて稀な脾Castleman病に対する腹腔鏡下脾摘術を経験したので報告する．症例は55歳の女性．無症状であったが，検診の腹部超音波検査で，脾臓に径4.5cmの充実性，境界明瞭，低エコーを示す占拠性病変を指摘された．腹部CTでは，造影早期相で辺縁優位に不均一に造影され，後期相では周囲脾組織との境界は不明瞭であった．腹部MRIでは，内部は不均一で，T2強調像，T1強調像とも等～低信号であった．脾腫瘍に対し診断的治療として手術を施行した．脾の授動に先立ち，脾動脈を結紮・切離し，腹腔鏡下に安全に施行できた．病理組織学的診断はCastleman病（hyaline-vascular type）であった．

　Castleman's disease originating from the spleen is extremely rare. We performed a laparoscopic splenectomy for Castleman's disease arising from the spleen. A 55-year-old woman, without any symptoms, underwent routine medical examination. Abdominal ultrasonoraphy detected a low echoic mass about 4.5 cm in diameter with clear border in the spleen. Contrast-enhanced CT scan showed the mass with peripheral dominant heterogeneous enhancement during the early phase and isoattenuation compared with the adjacent normal spleen during the late portal venous phase. Both T1 and T2-weighted MR image showed the mass to have heterogeneous content with iso to low intensity. Surgical resection of the splenic mass was performed as a diagnostic treatement. Laparoscopic splenectomy was performed safely by ligating and cutting splenic artery before mobilizing the spleen. Histologically the tumor was diagnosed as Castleman's disease（hyaline-vascular type）of the spleen.