腹腔鏡下に診断，治療しえた大網原発GISTの1例

Laparoscopic operation for gastrointestinal stromal tumor of the omentum : a case study

◆要旨：患者は53歳の男性で，健康診断にて腹部腫瘤を指摘され当院を受診した．腹部造影CTで胃上部左側，脾臓上極に接する，約9cmの不均一に造影される腫瘤性病変を認め，脾動脈および左下横隔動脈から栄養されていた．以上の所見より，大網原発腫瘍，特にgastrointestional stromal tumor（以下，GIST）を強く疑い，腹腔鏡下腫瘍切除術を行った．腹腔鏡下手術所見では，大網に径10cm大の表面が不整で軟な腫瘍が存在し，腹腔鏡下に切除術を行った．免疫組織化学検査所見で腫瘍はc-kit（＋），CD 34（＋）を示し，大網原発のGISTと診断した．術後3年経過した現在，再発所見はなく，外来経過観察中である．今回，筆者らは腹腔鏡下に切除し得た大網原発GISTの1例を経験したので報告する．

　A 53-year-old man came to our hospital complaining of intraabdominal mass which was detected by abdominal ultrasonography performed during the medical checkup in the summer of 2006. The abdominal enhanced computed tomography showed a slightly enhanced 9 cm tumor, side by side with the upper stomach and the spleen. The feeding artery of the tumor diverged from the splenic artery and the left subphrenic artery in the abdominal enhanced 3 D-CT angiography. Gastrointestinal stromal tumor（GIST）which grew from the greater omentum was strongly suspected and laparoscopic tumor resection was performed. An irregular and soft tumor was observed between the stomach and the greater omentum. Immunohistochemical findings showed that the tumor was c-kit（+）and CD 34（+）. From the operative, histopathological and immunohistochemical findings, the tumor was diagnosed as GIST of the omentum. There is no signs of recurrence, three years after the surgery.