胸腔鏡補助下で切除したPET陰性食道粘膜下腫瘍の1例

Thoracoscopic resection in a patient with esophageal submucosal tumor without radiotracer uptake on FDG-PET

◆要旨：術前にFDG-PETを用いて腫瘍の悪性度を判定した後に，侵襲軽減を目的として胸腔鏡下に切除した食道粘膜下腫瘍の1例を報告する．患者は44歳，男性．食物のつかえ感で発症し，食道造影および上部消化管内視鏡検査で長径3cm大の食道粘膜下腫瘍と診断された．術前FDG-PETでは集積を認めないものの，有症状であり本人希望により手術方針となった．3ポートと5cmの小切開を加え胸腔鏡下摘出術を行った．切除には内視鏡的バルーン法を併用し，食道の外膜と筋層は胸腔鏡下に縫合閉鎖した．術後経過は良好で第11病日に退院した．病理診断はc-kit・CD34陰性，SMA陽性で食道平滑筋腫であった．

　We report a patient with an esophageal submucosal tumor that was resected thoracoscopically after its malignancy was determined by preoperative F-18-fluorodeoxyglucose positron emission tomography（FDG-PET）. A 44-year-old man was referred to our hospital with dysphagia that persisted for 13 months. Esophagography and endoscopy revealed an esophageal submucosal tumor measuring 3 cm at its largest diameter, located at the middle thoracic esophagus. Although the tumor did not show concentration on FDG-PET, surgical resection was carried out because of severe clinical presentation. Thoracoscopic extirpation of the tumor was performed with three ports and a mini-thoracotomy site measuring 5 cm. Resection was performed with endoscopic balloon dilator assistance, and esophageal adventitia and muscular layer were closed thoracoscopically by the interrupted suture technique. The postoperative course was uneventful and the patient was discharged on postoperative day 11. Histopathological and immunohistochemical examinations showed that the tumor was negative for c-kit and CD 34, and positive for SMA. These findings were compatible with esophageal leiomyoma.