Ariyoshi Yosuke, Koizumi Noriaki, Yasuoka Rie, Nakamura Kenji, Fujiki Hiroshi, Shiozaki Atsushi, Fujiwara Hitoshi, Sakakura Chouhei
Division of Digestive Surgery, Akashi City Hospital.
Gan To Kagaku Ryoho. 2018 Dec;45(13):2267-2269.
A 58-year-old man was followed up for esophageal submucosal tumor at our hospital. Esophagogastroduodenoscopy showed the tumor was located on the left side of the thoracic esophagus and had gradually increased in size. Endoscopic ultrasonography revealed an 18×11.5mm hypoechoic tumor connected to the fourth layer of the esophagus and fine needle biopsy revealed c-kit(+), desmin(-)and a-SMA(-). Double-contrast barium study detected a tumor of diameter 20 mm in the middle-lower thoracic esophagus. We diagnosed an esophageal gastrointestinal stromal tumor(GIST)and performed mediastinoscope-assisted transhiatal esophagectomy with gastric tube reconstruction. The maximum tumor diameter was 25mm and pathological evaluation showed c-kit(+), Ki-67 index of less than 5%, and low-risk GIST by the Fletcher classification. Mediastinoscope-assisted transhiatal esophagectomy might be a useful approach for esophageal GIST, because dissection along the esophagus can be performed without thoracotomy.
一名58岁男性因食管黏膜下肿瘤在我院接受随访。食管胃十二指肠镜检查显示肿瘤位于胸段食管左侧，且大小逐渐增大。内镜超声检查发现一个18×11.5mm的低回声肿瘤，与食管第四层相连，细针穿刺活检显示c-kit(+)、结蛋白(-)和平滑肌肌动蛋白(-)。双重对比钡餐检查在胸段食管中下段发现一个直径20mm的肿瘤。我们诊断为食管胃肠道间质瘤(GIST)，并进行了纵隔镜辅助经裂孔食管切除术及胃管重建术。肿瘤最大直径为25mm，病理评估显示c-kit(+)，Ki-67指数小于5%，根据弗莱彻分类为低风险GIST。纵隔镜辅助经裂孔食管切除术可能是治疗食管GIST的一种有效方法，因为可以在不进行开胸手术的情况下沿食管进行解剖。
