腹腔鏡下に切除しえた穿孔性回腸GISTの1例

Laparoscopy-assisted surgery for gastrointestinal stromal tumor of the ileum with perforative peritonitis : a case report

◆要旨：患者は39歳の女性で，突然の下腹部痛を主訴に当院を受診した．血液生化学検査でWBC 16,800/mm3上昇と下腹部全体の圧痛，筋性防御反応，腹膜刺激症状を認めた．腹部造影CTでは小腸壁と連続した約5cmの腫瘤様構造を認めた．同日，回腸腫瘍の穿孔による汎発性腹膜炎の診断で，腹腔鏡補助下回腸部分切除術を行った．病理組織学的検査で，紡錘形細胞の錯綜増殖を認め，免疫組織化学的検査ではc-kit陽性，CD 34一部陽性で回腸gastrointestinal stromal tumorと診断した．核分裂像は3/50HPF以下，Ki-67（MIB-1）labeling indexは3％以下で低悪性度GISTの穿孔による腹膜炎であった．術後経過は良好で第10病日に退院した．その後，外来でimatinib mesylate（400mg）の内服を約1年行い，現在4年経過したが，無再発生存中である．

　We report a patient who underwent laparoscopy-assisted surgery for perforated gastrointestinal stromal tumor（GIST）of the ileum.

　A 39-year-old woman was brought to the emergency department because of the sudden abdominal pain. Physical examination revealed severe lower abdominal pain with rebound tenderness and guarding. The abdominal enhanced computed tomography（CT）showed an inflammatory tumor in the lower abdomen and a very small amount of free air. The patient was diagnosed as having panperitonitis due to ileal tumor perforation and she underwent urgent laparoscopic surgery on that same day. Laparoscopy showed a perforated ileal tumor about 100 cm from the ileum toward the mesenteries. Partial ileal resection was performed. Histopathological findings showed a tumor composed of proliferated spindle cells, arising from the musclaris propria of the ileum. Immunohistochemical findings showed c-kit（＋）, CD 34（＋）and the tumor was diagnosed as GIST of the ileum. The patient was treated with imatinib mesylate for a year. There is no sign of recurrence four years after the surgery.