汎発性腹膜炎を合併したpyomyomaの1例

A case of pyomyoma with peritonitis

子宮筋腫は婦人科腫瘍のなかで最も頻度の高い腫瘍である。pyomyoma（suppurative leiomyoma）は子宮筋腫に感染を伴い膿瘍形成をきたすまれな疾患であり，1871年に初めて報告され，これまで100例あまりの報告がある^1）2）。pyomyomaは早期の治療介入により予後を改善できるが，時に診断が難しく，診断の遅れから時として致死的結果につながる^3）。今回，汎発性腹膜炎を合併したpyomyomaの1例を経験したので文献的考察を加えて報告する。

Pyomyoma is a rare suppurative complication of leiomyoma. Whereas adequate surgery and broad-spectrum antibiotics may decrease serious morbidity, delayed diagnosis may result in serious morbidity. Here, we present a case of a 48-year-old G0P0 female with pyomyoma with peritonitis. CT and MRI showed a large lobulated solid mass with cystic components in the central area. The solid lesion showed iso intense as the myometrium on T1-weighted images and hypointense on T2-weighted images, and was enhanced equally as the myometrium. The cystic lesion in the central area was heterogeneously shown as hyperintense on diffusion-weighted MR images, and was not enhanced on gadolinium-enhanced fat-suppressed T1-weighted images, suggesting the presence of purulent or viscous fluid. Moreover, contrast-enhanced CT images and gadolinium-enhanced fat-suppressed T1-weighted images showed ascites and diffuse, smooth thickening of the peritoneum, suggesting the presence of peritonitis. Subtotal hysterectomy with bilateral salpingo-oophorectomy was performed and the mass was finally diagnosed as pyomyoma.