腹腔鏡下に切除した後腹膜平滑筋腫の1例

Retroperitoneal leiomyoma treated by laparoscopic resection : a case report

◆要旨：患者は47歳，女性．婦人科検診で骨盤内腫瘍を指摘されて当院に紹介となった．腹部CT上骨盤内右側に40mm程度に軽度造影される境界明瞭な腫瘤を認め，腹部MRIでは右卵巣が腫瘤とは別に描出されており，大腸内視鏡検査，小腸造影検査ではともに所見を認めなかった．以上の所見より後腹膜腫瘍または腸間膜原発の消化管間葉系腫瘍を疑い腹腔鏡下腫瘍切除術を施行した．病理組織学的所見ではα-SMA陽性，デスミン陽性であり平滑筋腫と診断された．後腹膜腫瘍は悪性腫瘍の頻度が高く，術前診断は困難な場合が多い．腹腔鏡下手術は後腹膜腫瘍の診断および治療に有用なものと思われた．

　A 47-year-old womon was referred to our department with a diagnosis of a pelvic tumor. Abdominal CT showed a well demarcated mass with mild contrast enhancement about 40 mm size in the right side of the pelvis. Pelvic MRI showed normal right ovary separate from the tumor. There were no findins in colonoscopy and the small bowel series. With a pre-operative diagnosis of retroperitoneal tumor or gastro intestinal stromal tumor（GIST）, we performed laparoscopic resection of the tumor. Since the immunohistochemical staining was positive forα-smooth muscle actin（α-SMA）and desmin, so we made a diagnosis of retroperitoneal leiomyoma. In retroperitoneal tumors, the incidence of malignancy is relatively high, and precise preoperative diagnosis is difficult. Laparoscopic surgery is considered to be useful for diagnosis and treatment of retroperitoneal tumors.