ポートサイト再発をきたした胃GISTの1例

Navel port site recurrence after laparoscopic partial gastrectomy for gastric GIST : a case report

◆要旨：患者は，79歳，女性．胃粘膜下腫瘍に対して，腹腔鏡下胃部分切除術を施行した．管内管外発育性の大きさ3.8cmの腫瘤であったが，漿膜浸潤はなく，臍ポートサイトより摘出し得た．術後病理診断は，c-kit（＋），CD 34（＋）の胃GISTで，水平断端陰性，漿膜浸潤も認めなかった．初回手術から1年半後に臍部に腫瘤が出現し，増大傾向を認めた．腹部CTでは，臍部腹壁内に造影剤で濃染される大きさ3cmの腫瘤を認め，PETでは，同部に強いフルオロデオキシグルコース（FDG）の集積を認めた．臍部ポートサイトの再発を疑い，腹壁腫瘤摘出術を施行した．病理組織学的に，GISTの転移に合致する所見であった．

　We report a patient with umbilicus or navel port site recurrence after laparoscopic partial gastrectomy for gastric GIST. A 79-year-old women underwent laparoscopic partial gastrectomy for gastric submucosal tumor. The tumor protruded outside and inside of the wall with size of 3.8 cm, and no serosal invasion, was removed from the navel port. Postoperative histological examination revealed the tumor was gastric GIST with c-kit（+）and CD 34（+）staining, and the tumor cells were free from the edge and serosa of the gastric speciemen. One and a half year after the first operation, a tumor appeared at the navel of the abdominal wall and it was increasing in size. Abdominal CT showed a 3 cm tumor enhanced by a contrast medium within the abdominal wall at the navel. PET showed a strong accumulation of FDG at the site. It was diagnosed as a navel port site recurrence of gastric GIST and abdominal tumor resection was performed. Pathological examination agreed with the metastasis of GIST.