左閉鎖孔に発生したリンパ管腫に対し腹腔鏡下切除を行った1例

Laparoscopic resection in a case of lymphangioma that occurred in the obturator foramen

◆要旨：後腹膜から発生するリンパ管腫は比較的稀といわれており，閉鎖孔に発生した報告はない．今回，閉鎖孔に発生したリンパ管腫に対し腹腔鏡下切除を行った1例を経験したので報告する．症例は27歳，男性．左下肢の痛みやだるさ，しびれを主訴に受診した．CT，MRIにて左閉鎖孔内に55mm大の単房性囊胞腫瘤を認め，リンパ管腫が疑われ，腹腔鏡下腫瘍切除術を行った．腫瘍は左閉鎖孔を占拠し，閉鎖神経を背側に圧排していた．神経，血管を温存し腫瘍を摘出した．切除後，下肢の症状は改善した．病理組織学的にD2-40抗体陽性でリンパ管腫と診断した．脈管，神経が複雑な閉鎖孔の腫瘍に対しても，腹腔鏡下手術は有用であった．

Retroperitoneal lymphangioma is a relatively rare occurrence, and no such case has been previously reported to occur in the obturator foramen. We herein report a laparoscopic resection in a case of lymphangioma that occurred in the left obturator foramen. A 27-year-old male presented to our hospital with pain, languor and numbness of his left leg. A monocystic tumor measuring 55 mm in size was identified in the left obturator foramen on CT and MRI examinations. Lymphangioma was suspected and laparoscopic resection was performed. The left obturator foramen was occupied by the tumor and the obturator nerve was observed to have been pressed down. All vessels and nerves were meticulously lysed and preserved during the laparoscopic excision of the tumor. The symptoms in his leg improved after the operation. A diagnosis of lymphangioma was made based on the histopathologically positive finding of D2-40 antibody. Laparoscopic surgery was successfully performed to remove the tumor in the obturator foramen where many vessels and nerves were complicated.