術前診断しえた胃glomus腫瘍に対し腹腔鏡・内視鏡合同胃局所切除術を施行した1例

A case of glomus tumor of the stomach resected by laparoscopy endoscopy cooperative surgery

◆要旨：患者は58歳，女性．検診で胃前庭部の粘膜下腫瘍を指摘され経過観察となった．2年8か月後の内視鏡検査で増大傾向を認め，精査を行った．造影CTでは胃内腔に発育する非常に血流に富む腫瘤を認めた．EUSで固有筋層の低エコー腫瘤を認め，針生検で胃glomus腫瘍と診断した．腫瘍が胃内発育型を示すことから腹腔鏡・内視鏡合同胃局所切除術（LECS）を行った．内視鏡操作で切離線を決定することで，過不足のない切除が可能であった．胃glomus腫瘍は稀な胃粘膜下腫瘍であり，術前診断は困難とされる．胃内発育型を呈しており，LECSが有用であったと思われた．

A 58-year-old woman, who was found to have a submucosal tumor（SMT） of the antrum in medical checkup 32 months previously, was admitted for enlargement of the SMT observed by endoscopy. CT showed a well-enhanced tumor with intraluminal growth in the antrum. Endoscopic ultrasonography showed hypoechoic tumor in the proper muscular layer. Histological examination of fine needle aspiration biopsy revealed a glomus tumor. Because the tumor formed intraluminal growth, laparoscopy endoscopy cooperative surgery（LECS） was performed. The tumor was resected along the line determined by endoscopy without excessive surgical resection of the gastric wall. Glomus tumor of the stomach is a rare and is difficult to diagnose preoperatively. LECS is useful for resecting submucosal tumor of the stomach with intraluminal growth.