腹腔鏡下手術で切除しえた鼠径部・閉鎖腔に発生した後腹膜脱分化型脂肪肉腫の1例

Laparoscopic resection of retroperitoneal dedifferentiated liposarcoma : a case report

◆要旨：患者は54歳，男性．他院にて後腹膜腫瘍を指摘されて当科を紹介受診した．腹部造影CT検査で，右鼠径部後腹膜腔・閉鎖腔にモザイク状の造影効果を示す，長径がそれぞれ52mm，23mm大の腫瘤を認め，いずれもPETで高集積を認めた．後腹膜悪性腫瘍と診断し，直腸癌に対する側方リンパ節郭清に準じて腹腔鏡下手術を施行した．まず閉鎖腔外側・尾側を剝離し，続いて内腸骨血管に沿った剝離を進め，閉鎖腔の腫瘍を摘出した．鼠径部の腫瘍は，精索および下腹壁動静脈を合併切除して露出なく切除しえた．術後12日目に合併症なく退院した．病理組織学的診断では脱分化型脂肪肉腫であった．補助療法は施行せず，術後1年の現在，経過観察中である．

A 54-year old male with retroperitoneal tumors within the pelvis was referred to our hospital. Abdominal contrast enhanced CT showed heterogeneously enhanced tumors at right inguinal and obturator space. FDG-PET/CT revealed high FDG uptake in both tumors. These were diagnosed as retroperitoneal malignant tumors and laparoscopic resection was performed in accordance with lateral lymph node resection for rectal cancer. First, the obturator tumor was dissected, and then the inguinal tumor was resected combined with the spermatic cord and inferior epigastric vessels. R0 resection was successfully achieved. The postoperative course was uneventful and the patient was discharged on postoperative day 12. Histopathological diagnosis of the tumors was dedifferentiated liposarcoma. The patient is doing well one year after surgery, with no signs of recurrence.