腹腔鏡・内視鏡合同胃局所切除術にて切除しえた胃glomus腫瘍の1例

A case report of laparoscopy endoscopy cooperation surgery for a glomus tumor of the stomach

◆要旨：患者は55歳，女性．上腹部痛の訴えがあり腹部CT検査を施行したところ，多血性の胃壁腫瘤を指摘され，また上部消化管内視鏡検査では前庭部大彎側に20mm大の粘膜下腫瘍を認めた．穿刺吸引法にて生検を行ったところglomus腫瘍あるいはGISTが疑われ，腹腔鏡・内視鏡合同胃局所切除術を施行した．全身麻酔下で内視鏡下に腫瘍辺縁を切開し，腹腔鏡下に漿膜筋層を切離した．腫瘍摘出後，自動縫合器により胃壁を縫合閉鎖した．切除標本の免疫染色にてSMA陽性，c-kit陰性，PDGFRα遺伝子変異陰性でありglomus腫瘍と診断した．合併症は認めず，術後9日目に退院となった．胃原発のglomus腫瘍は比較的稀な疾患であるが，リンパ節転移の報告もなく，本術式が有効かつ妥当と考えられた．

　A 55-year-old woman was admitted to the hospital for upper abdominal pain. She was a known case of collagen disease. Abdominal computed tomography and upper gastrointestinal endoscopy showed a 20-mm submucosal tumor in the major curvature of the pyloric area. Fine-needle aspiration biopsy was performed and epithelial cell type gastrointestinal stromal tumor or glomus tumor was suspected based on the results. Laparoscopic and endoscopic cooperation surgery was performed under general anesthesia. The tumor margin was incised endoscopically and the serosal muscle layer was laparoscopically resected. After removing the tumor, the stomach wall was closed with an automatic suturing device. Immunostaining of the resected specimens showed negative results for c-kit, S-100, Desmin, and PDGFRα gene mutation. These findings were compatible with a diagnosis of glomus tumor. The postoperative course was uneventful, and the patient was discharged on the ninth postoperative day. Glomus tumor of the stomach is relatively rare, but there are a few reports of metastasis. Therefore, this procedure was considered effective and reasonable.