腹腔鏡下に切除した大網由来Castleman's diseaseの1例

Castleman's disease which originated from the greater omentum : a case report

◆要旨：患者は56歳，男性．人間ドックの腹部超音波検査にて胃壁外の腫瘤を指摘され，精査のため当院に紹介された．画像診断にて胃原発のgastrointestinal stromal tumor（以下，GIST）を強く疑い手術を施行した．腫瘤は胃前庭部大彎近傍にあり，右胃大網動脈を栄養血管とする径3.5cm大の白色，表面平滑な腫瘤であった．腫瘤は胃，横行結腸とは間隙があることから，大網原発の腫瘍と考えられた．腹腔鏡下に腫瘍を切除した．病理検査報告書ではCastleman's disease（mixed type）であった．本症例のような良性疾患である腫瘍に対し低侵襲である腹腔鏡下手術は有用であると考えられた．

　A 56-year-old man was referred to our hospital for further examination of an abdominal tumor found by physical examination. A solid mass measuring 3.3×2.7 cm in size adjacent to the greater curvature of the gastric antrum was detected by abdominal ultrasonography. Abdominal computed tomography showed a homogenous contrast-enhancement, leading to a preoperative diagnosis of gastrointestinal stromal tumor（GIST）. Laparoscopic observation demonstrated a white mass with a smooth surface, 3.5 cm in diameter, originated from the greater omentum and was fed by the right gastroepiploic artery. The tumor was resected laparoscopically and was pathologically diagnosed as Castleman's disease. Considered to be a borderline disease between reactive lymphadenopathy and lymphoid tumor, Castleman's disease is difficult to differentiate accurately from other diseases like GIST and malignant lymphoma, therefore laparoscopic management seems to be beneficial.