腹腔鏡補助下幽門保存胃切除後リンパ節再発と鑑別困難であったSchloffer腫瘍の1例

A case of Schloffer tumor, initially suspected to be lymph node recurrence, after laparoscopy-assisted pylorus-preserving gastrectomy

◆要旨：患者は57歳の男性で，胃体部早期癌（cT1，N0，Stage IA）に対して腹腔鏡補助下幽門保存胃切除術を施行した．術後合併症はなく退院し，最終病理組織学的検査でもT1，N0であった．外来での経過観察中，術後2か月時に腫瘍マーカー（CEA）の上昇を認め，腹部CTで幽門下領域に20mm大の腫瘤を認めた．再発の可能性を否定できず，手術とした．腹腔鏡下に腫瘤を切除して術中迅速病理診断に提出したところ，悪性所見を認めない炎症組織との結果であった．最終病理診断は縫合糸膿瘍が否定できない異物肉芽腫（Schloffer腫瘍）であった． 非特異的な腫瘍マーカー上昇を伴うSchloffer腫瘍の1例を経験した．

The present report describes a case of Schloffer tumor with non-specific tumor marker elevation. A 57-year-old man had undergone laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer and had been discharged without any postoperative complications. The histopathological finding was T1（M） N0 Stage IA. Two months after surgery, serum carcinoembryonic antigen levels were elevated and abdominal computed tomography revealed a 20-mm diameter tumor in the pyloric region. Lymph node recurrence was suspected, so additional surgery was performed and the tumor was removed laparoscopically. The intraoperative pathological diagnosis（frozen section） was inflammatory tissue with no findings of malignancy. The final pathological diagnosis was foreign body granuloma（Schloffer tumor）.