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[胃癌腹腔镜胃切除术后可切除性腹腔内硬纤维瘤两例]

[Two Cases of Resectable Intra-Abdominal Desmoid Tumor after Laparoscopic Gastrectomy for Gastric Cancer].

作者信息

Ajiki Takashi, Yamauchi Junichiro, Shirasaki Keiichi, Fujita Shota, Sato Mamoru, Ikeda Tomoya, Miura Tomoya, Tsuchihara Katsuo

机构信息

Dept. of Gastroenterological Surgery, Sendai Kousei Hospital.

出版信息

Gan To Kagaku Ryoho. 2019 Jan;46(1):118-120.

Abstract

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.

摘要

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。

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