DSpace Fukushima Medical University

福島県立医科大学学術成果リポジトリ = Fukushima Medical University Repository >
福島医学会 = The Fukushima Society of Medical Science >
福島医学雑誌 = Fukushima Medical Journal >
Vol.74 (2024) >
Vol.74 No.2 (2024) >

Please use this identifier to cite or link to this item: http://ir.fmu.ac.jp/dspace/handle/123456789/2451

Files in This Item:

File Description SizeFormat
FksmMedJ_74_p41.pdf1.89 MBAdobe PDFDownload
Title: 腹腔鏡下に切除した腫瘍内感染を伴う胃gastrointestinal stromal tumorの1例
Other Titles: A case of gastric gastrointestinal stromal tumor with abscess resected by laparoscopic surgery
Authors: 叶多, 諒
花山, 寛之
松石, 彬
丸山, 裕也
目黒, 啓予
松井田, 元
金田, 晃尚
楡井, 東
菊池, 智宏
佐瀬, 善一郎
橋本, 優子
河野, 浩二
Affiliation: 消化管外科学講座
病理病態診断学講座
Source title: 福島医学雑誌
Volume: 74
Issue: 2
Start page: 41
End page: 46
Issue Date: 2024
Abstract: 胃消化管間質腫瘍(gastrointestinal stromal tumor, GIST)は腫瘍径の増大に伴い内部の変性,出血,壊死をきたすことがあり,腫瘍内部の感染を呈する場合がある。症例は82歳女性。近医で施行された上部消化管内視鏡検査(esophagogastroduodenoscopy, EGD)で穹窿部に粘膜下腫瘍を指摘され,当院紹介となった。当院で施行したEGDでは穹窿部にdelleを伴う56×47mmの粘膜下腫瘍を認めた。超音波内視鏡下穿刺吸引法を施行しGISTの診断となり手術待機中であったが,意識障害,体動困難のため前医に救急搬送された。造影CT検査で腫瘍径の増大および内部のairを伴う液体貯留を認めた。血液検査では著明な炎症反応の上昇を認め,胃GISTの腫瘍内感染の診断で抗菌薬による加療を開始した。当院転院後にEGDを行ったがすでに胃内に穿通し膿性の排液が認められたため追加でのドレナージは施行しなかった。感染のコントロールが得られ,待機的に腹腔鏡下胃局所切除術を施行した。術後経過は良好で術後14日目にリハビリ目的に転院した。病理組織学的検査では腫瘍径は4.0×3.0mmで断端は陰性だった。modified Fletcher分類で再発超低リスク群の胃GISTの診断となり術後補助療法は施行せず,術後4ヶ月再発なく経過している。今回,腫瘍内感染から敗血症に至ったものの,保存的加療により腫瘍の縮小が得られたため腹腔鏡下胃局所切除術を施行した胃GISTの症例を経験した。胃GISTの腫瘍内感染は適切にドレナージが施行され,感染コントロールが得られれば腹腔鏡下に安全に低侵襲な手術が可能である。胃GISTの腫瘍内感染を発症した症例のうち待機的に手術を行った症例について文献的考察を含めて報告する。
Table of Contents: Gastrointestinal stromal tumors (GISTs) can undergo degeneration, bleeding, and necrosis as they grow, sometimes leading to intra-tumoral infection. We present the case of an 82-year-old woman who was referred to our hospital after a submucosal tumor was discovered in her gastric fornix during an esophagogastroduodenoscopy (EGD) conducted at a nearby medical facility. During the EGD at our hospital, we observed a submucosal tumor measuring 56×47 mm with a delle in the gastric fornix. Endoscopic ultrasound-guided fine needle aspiration confirmed the diagnosis of GIST. While awaiting surgery, the patient was transferred back to the previous medical facility due to altered consciousness and difficulty in movement. A contrast-enhanced CT scan revealed an enlarged tumor with fluid accumulation and air inside, indicating infection. Blood tests showed significantly elevated inflammatory markers, confirming the diagnosis of intra-tumoral infection in the gastric GIST. Antibiotic therapy was initiated accordingly. Upon returning to our hospital, repeat upper gastrointestinal endoscopy revealed pus drainage into the stomach. Infection was successfully controlled, and the patient underwent laparoscopic local resection of the gastric GIST. Postoperative recovery was uneventful, and the patient was transferred for rehabilitation on postoperative day 14. Pathological examination of the resected tumor revealed negative margins, indicating a very low risk for recurrence according to the modified Fletcher classification. No adjuvant therapy was administered, and the patient remained recurrence-free at the 4-month follow-up. Despite the development of sepsis from intra-tumoral infection, conservative management led to tumor reduction, enabling a safe and minimally invasive laparoscopic local resection of the gastric GIST. This case highlights the successful treatment of gastric GIST with intra-tumoral infection using a conservative approach followed by surgical intervention.
Publisher: 福島医学会
language: jpn
URI: http://ir.fmu.ac.jp/dspace/handle/123456789/2451
Full text URL: http://ir.fmu.ac.jp/dspace/bitstream/123456789/2451/1/FksmMedJ_74_p41.pdf
ISSN: 0016-2582
2436-7826
DOI: 10.5387/fmedj.74.2_41
Related Page: https://doi.org/10.5387/fmedj.74.2_41
Rights: © 2024 福島医学会
Appears in Collections:Vol.74 No.2 (2024)

Files in This Item:

File Description SizeFormat
FksmMedJ_74_p41.pdf1.89 MBAdobe PDFDownload

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.

 

DSpace Software Copyright © 2002-2007 MIT and Hewlett-Packard