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Please use this identifier to cite or link to this item: http://hdl.handle.net/10087/5583

Title: 骨盤内臓全摘後4年間無再発の巨大直腸gastrointestinal stromal tumorの1例
Other Titles: A Giant Gastrointestinal Stromal Tumor of the Rectum Resected Successfully using Total Perineal Exenteration
Authors: 須納瀬, 豊
竹吉, 泉
富澤, 直樹
川手, 進
浜田, 邦弘
東郷, 望
戸谷, 裕之
大和田, 進
桜井, 信司
森下, 靖雄
Keywords: gastrointestinal stromal
tumor
rectum
c-kit
Issue Date: 1-Apr-2007
Publisher: 日本消化器外科学会
Citation: 日本消化器外科学会雑誌 40(4), 497-503 (2007)
Abstract: 患者は61歳の男性で,平成14年4月,下血と肛門部痛のため近医を受診し,直腸診で腫瘤を指摘され当院に紹介された.大腸内視鏡検査で,直腸に中心臍窩を伴う巨大な粘膜下腫瘍を認めた.CTとMRIで,直腸前壁に径12cm大の内部不均一な腫瘤影があり,前立腺との境界も不明瞭であった.FDG-PETでは,腫瘤に一致して異常集積を認めた.画像および生検の所見より,直腸GISTの前立腺浸潤と診断し,同年5月に骨盤内臓全摘術を施行した.切除標本では,中心壊死を伴う浸潤性の病変で,組織学的にも前立腺に浸潤していた.核分裂像を50視野中13個認め,免疫染色ではc-kit, CD34が陽性で,高リスクのGISTと診断された.巨大な直腸GISTに骨盤内臓全摘術を行い,治癒切除後4年,無再発の症例を経験した.再発のリスクは治癒切除の可否で左右されるため,適切な切除による根治性の高い手術を行うことが重要である. A 61-year-old man see for complaining of anal bleeding and pain, and was found in Colonoscopy to have a giant submucosal tumor with central ulceration in the rectum. Computed tomography and magic resonance imaging showed a 12cm heterogeneous mass in the pelvic space invading the prostate. FDG-PET showed abnormal tracer accumulation in the tumor, which was diagnosed as gastrointestinal stromal tumor (GIST) with prostate invasion and resected radically using total perineal exenteration. The resected specimen showed hemorrhagic necrosis of a massive tumor. The mitotic count was 13 per 50 in the high-power field. Immunohistochemical staining detected c-kit and CD34 but was negative for desmin, α-SMA, S-100 protein, and NSE. The tumor was defined as high-risk in risk assessment We report a case of giant GIST of the rectum resected successfully using total perineal exenteration, following which the patient has remained disease-free for 4 years. Because the risk of the recurrence depends on the operation curability, adequate resection margin is needed for surgical approach for GIST.
URI: http://hdl.handle.net/10087/5583
ISSN: 03869768
Appears in Collections:学術雑誌論文

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