経肛門的内視鏡下マイクロサージェリーによる直腸全層切除術を施行した直腸GISTの2例

Two cases of rectal GIST treated by transanal endoscopic microsurgery

◆要旨：直腸gastrointestinal stromal tumor（GIST）は稀な疾患である．筆者らは直腸GISTに対し，経肛門的内視鏡下マイクロサージェリー（TEM）による全層切除を施行した症例を2例経験したので報告する．症例1は74歳，女性．検診の下部内視鏡検査にて，直腸に直径約3cmの粘膜下腫瘍を認め，生検にてGISTと診断された．TEMによる全層切除術により局所切除を行い，病理所見で断端陰性を得た．術後1年6か月の時点で，再発兆候を認めていない．症例2は54歳，男性．血便精査の下部内視鏡検査にて，直腸に直径約2cmの粘膜下腫瘍を認め，生検にてGISTと診断された．TEMによる全層局所切除術を行い，病理所見で断端陰性を得た．術後7か月の時点で，再発兆候を認めていない．

Two cases of rectal gastrointestinal stromal tumor（GIST） treated by transanal endoscopic microsurgery（TEM） are herein reported. Case 1 : A 74-year -old woman was admitted to our hospital with lower rectal GIST. Colonoscopy showed a submucosal tumor,3cm in diameter with a smooth surface on the left wall of the rectum. Fine needle biopsy led to a diagnosis of GIST. Local resection was performed by TEM. Histological and immunohistochemical diagnosis indicated GIST with low risk . No recurrence was seen at a year and a half follow up. Case2: A 54-year -old man was admitted to our hospital with lower rectal GIST. Colonoscopy showed a submucosal tumor,2cm in diameter on the anterior wall of the rectum. Fine needle biopsy led to a diagnosis of GIST. Local resection was performed by TEM. Histological and immunohistochemical diagnosis indicated GIST with low risk. No recurrence was seen at a 6 months follow up. TEM can be a preferable option in the surgical treatment of rectal GIST when the patients are appropriately selected.