腹腔鏡下に摘出しえた下十二指腸角GISTの1例

Laparoscopic resection of a GIST located in the intraduodenal angle : A case report

◆要旨：患者は65歳，男性．黒色便を主訴に当院を受診した．上部消化管内視鏡で下十二指腸角に粘膜下腫瘍を認め，CTで同部位に29mm大の壁外突出性の腫瘍を認めた．Gastrointestinal stromal tumor（GIST）の診断で腹腔鏡下十二指腸部分切除を施行した．術後経過は良好で，術後14日目に退院となった．病理結果はc-kit陽性，CD34陽性でGISTと診断し，Fletcher分類の低リスクであったため追加治療はせず，現在術後2年6か月で無再発生存中である．腹腔鏡下手術は十二指腸GISTに対する有用な治療の1つであると考えられた．

A 65-year-old man with a chief complaint of black stool visited our hospital. Upper GI endoscopy revealed a submucosal tumor located in the intraduodenal angle on the opposite of the pancreas. Abdominal CT showed a 29 mm solid mass located outside of duodenum. Laparoscopic partial duodenectomy was performed for tumor resection. The patient was discharged on the 14th post-operative day without complications. Immunohistological staining showed positive for c-kit, positive for CD34. Histopathological diagnosis was duodenal gastrointestinal stromal tumor（GIST） with low risk grade of Fletcher's classification. The patient has no recurrence without adjuvant chemotherapy for 30 months. Laparoscopic surgery suggested useful for duodenal GIST.