肝十二指腸間膜内に血腫を形成し腹腔鏡下生検にて確定診断しえた原発性アミロイドーシスの1例

A case of amyloidosis diagnosed by laparoscopic biopsy of a hematoma in the hepatoduodenal ligament

◆要旨：症例は37歳，男性．心窩部痛で近医救急受診したところ，肝十二指腸間膜に腫瘤性病変を指摘された．精査にて肝十二指腸間膜に発生した血腫が疑われたが，組織生検ができず確定診断は困難であった．徐々に増大傾向を示したことから，腹腔鏡下に腫瘤切除を行った．術後経過は問題なく，術後2日目に退院となった．病理組織学的には腫瘤被膜にアミロイド沈着を認めた．術後出血傾向を認めたが，原発性アミロイドーシスの診断のもと化学療法を導入し速やかに改善した．肝十二指腸間膜に発生した腫瘤に対して，確定診断を得る方法として腹腔鏡下手術は有用であり選択肢の1つになると考えられた．

　A 37-year-old man presented to a hospital emergency with epigastric pain and was noted to have a mass lesion in the hepatoduodenal ligament. Hepatoduodenal ligament hematoma was suspected by imaging studies including contrast-enhanced computed tomography, magnetic resonance imaging, and positron emission tomography. However, a definitive diagnosis was difficult to make because a tissue biopsy was not available. As the mass gradually grew, we performed a laparoscopic resection. Pathology revealed amyloid deposits in the tumor capsule. The patient was discharged early postoperatively, but was readmitted to the hospital 11 days postoperatively due to anemia and bleeding tendency due to amyloidosis. Treatment for amyloidosis was introduced, and the bleeding tendency rapidly improved.