腹腔鏡下に摘出しえた十二指腸GISTの1例

GIST of the duodenum successfully treated by laparoscopic surgery : a case report

◆要旨：患者は58歳，女性．健診目的に施行した腹部CT検査で腹腔内腫瘍を指摘された．上部消化管内視鏡で十二指腸下行脚乳頭対側に表面平滑な粘膜下隆起性病変を認め，超音波内視鏡で粘膜下から壁外へ突出する径3.5cmの低エコー腫瘤像として描出された．十二指腸gastrointestinal stromal tumor（以下，GIST）と診断し，腹腔鏡下十二指腸部分切除術を施行した．術後は良好に経過し，第13病日に退院した．病理組織学的にc-kitが弱陽性，CD34が陽性，Ki-67 labeling indexは2～3％であり，GIST, low risk gradeと診断した．現在2年8か月経過したが再発は認めず，経3.5cmの十二指腸GISTに対する腹腔鏡下手術の有用性が示唆された．

　A 58-year-old woman was referred to surgery with an incidentally discovered intraabdominal mass. Abdominal CT showed a 3.5cm well-enhanced solid mass located outside of the duodenum. Upper GI endoscopy and endoscopic ultrasonography revealed a submucosal tumor located at the second portion of the duodenum on the opposite site of the pancreas. Laparoscopic partial duodenectomy was performed for the definite diagnosis and tumor resection. Immunohistological staining showed partially positive for c-kit, positive for CD34 and 2～3% for Ki-67 labeling index. Histopathological diagnosis was duodenal gastrointestinal stromal tumor （GIST） with low grade risk. The patient was discharged on the 13th post-operative day without complications and has no recurrence for 2 years 8 months. Laparoscopic surgery thus suggested useful for 3.5cm duodenal GIST.