Hariu Tomoki, Nako Yoshihito, Yamasaki Shigeki, Kitade Takashi, Wakasa Motomi, Sonoyama Teruhisa
Dept. of Surgery, Kitade Hospital.
Gan To Kagaku Ryoho. 2016 Nov;43(12):2383-2385.
During treatment for sigmoid colon diverticulitis, a 72-year-old man underwent abdominal computed tomography, which revealed a gastric tumor that was approximately 40mm in diameter. He then underwent a detailed examination after the remission of diverticulitis. The gastric mucosa was found to be unremarkable on gastrointestinal endoscopy. On ultrasonic endoscopy, however, a hypoechoic mass of approximately 40mm in diameter was detected in the fourth layer of the gastric fornix and was believed to be a gastric submucosal tumor(SMT). The tumor was laparoscopically resected, and histological analysis of the tumor revealed a high-risk gastrointestinal stromal tumor(GIST, modified-Fletcher classification). In many cases, when subgastric SMTs are approximately 2-5 cm in diameter and are without obvious malignant findings on endoscopic or computed tomographic examinations, they are followed-up. However, some recent case reports describing treatments for high- or medium-risk groups of patients with small GISTs have been published. When a small submucosal gastric tumor is suspected to be GIST, we believe that laparoscopic surgery is a minimally invasive and effective method for the diagnosis and treatment of the tumor.
在乙状结肠憩室炎治疗期间，一名72岁男性接受了腹部计算机断层扫描，结果显示一个直径约40mm的胃肿瘤。憩室炎缓解后，他接受了详细检查。胃肠内镜检查发现胃黏膜无明显异常。然而，超声内镜检查发现胃穹窿第四层有一个直径约40mm的低回声肿块，被认为是胃黏膜下肿瘤（SMT）。该肿瘤通过腹腔镜切除，肿瘤组织学分析显示为高危胃肠道间质瘤（GIST，改良弗莱彻分类）。在许多情况下，当胃黏膜下肿瘤直径约为2 - 5cm，且在内镜或计算机断层扫描检查中无明显恶性表现时，会进行随访。然而，最近有一些病例报告描述了对小GIST高危或中危组患者的治疗。当怀疑小的胃黏膜下肿瘤为GIST时，我们认为腹腔镜手术是诊断和治疗该肿瘤的一种微创且有效的方法。
