粘膜下腫瘍様の形態を呈した胃重複囊胞に対して腹腔鏡下胃部分切除術を施行した1例

Laparoscopic partial gastrectomy for duplication cyst of the stomach resembling submucosal tumor

◆要旨：患者は57歳，女性．検診の上部消化管造影検査で異常を指摘され当院を紹介された．造影CT検査やMRI検査で胃穹隆部と脾臓の間に境界明瞭な内部に造影効果のない約5cm大の囊胞性病変を認めた．囊胞性変化を伴う胃間葉系腫瘍や神経内分泌腫瘍，表皮囊胞を疑い，診断的治療を目的に腹腔鏡下胃部分切除術を施行した．病理組織学的な所見で大部分の囊胞壁は線維・硝子化していたが，一部では胃の腺窩上皮や多列繊毛上皮が裏打ちしており胃重複囊胞と診断した．胃重複囊胞は稀な疾患であるため，様々な鑑別疾患とともに術前診断は困難である場合もあるが，診断・治療のための腹腔鏡下手術は有用な方法と考えられた．

We report a case of duplication cyst which was treated with laparoscopic partial gastrectomy. A 57-year-old female with an asymptomatic gastric tumor diagnosed incidentally was admitted to our hospital. Computed tomography and magnetic resonance imaging showed a cystic lesion, 5cm in diameter, without contrast enhancement between the fornix of the stomach and the spleen. The gastrointestinal tumor, neuroendocrine tumor with cystic change or epidermal cyst was suspected. Laparoscopic partial gastrectomy was performed for diagnosis and treatment. Histological examination revealed that most of the cyst walls showed fibrotic change and hyalinization. However, crypt epithelium and pseudostratified epithelium were also partially observed. Thus, the tumor was diagnosed as duplication cyst of the stomach. Duplication cyst of the stomach is a rare disease and is considered to be difficult to diagnose preoperatively. Therefore, laparoscopic surgery might be useful for the treatment and diagnosis.