Ajiki Takashi, Yamauchi Junichiro, Shirasaki Keiichi, Fujita Shota, Sato Mamoru, Ikeda Tomoya, Miura Tomoya, Tsuchihara Katsuo
Dept. of Gastroenterological Surgery, Sendai Kousei Hospital.
Gan To Kagaku Ryoho. 2019 Jan;46(1):118-120.
Case 1: A 52-year-old man underwent laparoscopic total gastrectomy for gastric cancer. After 2 years, a follow-up computed tomography(CT)scan showed a large, solid 10 cm-sized mass in his left upper abdomen. Under the diagnosis of a suspected mesenchymal tumor, a tumor resection with a partial resection of the upper jejunum and transverse colon was performed. Case 2: A 61-year-old man underwent laparoscopic pylorus-preserving gastrectomy for gastric cancer. After 1.5 years, follow-up CT showed a tumor of 2 cm in diameter near the greater curvature side of the upper stomach. Under the diagnosis of a suspected gastrointestinal stromal tumor(GIST), a laparoscopic partial resection of the stomach was performed. Histologically, spindle-shaped cells without atypia and rich collagen fibers were observed, and the sample was positive for b-catenin by immunostaining in both cases; from this evidence, the patients were diagnosed with desmoid tumors. Desmoid tumors have invasive proliferation characteristics, and treatment requires consideration of the balance between securing a surgical margin and increasing surgical stress.
病例1：一名52岁男性因胃癌接受了腹腔镜全胃切除术。2年后，随访计算机断层扫描（CT）显示其左上腹有一个10厘米大小的实性大肿块。在疑似间叶组织肿瘤的诊断下，进行了肿瘤切除术，同时部分切除了空肠上段和横结肠。病例2：一名61岁男性因胃癌接受了腹腔镜保留幽门胃切除术。1.5年后，随访CT显示胃上部大弯侧附近有一个直径2厘米的肿瘤。在疑似胃肠道间质瘤（GIST）的诊断下，进行了腹腔镜胃部分切除术。组织学检查发现，两例均观察到无异型性的梭形细胞和丰富的胶原纤维，样本免疫染色β-连环蛋白呈阳性；根据这些证据，患者被诊断为硬纤维瘤。硬纤维瘤具有侵袭性增殖特征，治疗需要考虑确保手术切缘与增加手术应激之间的平衡。
