Shibata Ryosuke, Morishita Marina, Koreeda Nobuhiko, Hirano Yousuke, Kaida Hiroki, Ohmiya Toshihiro, Uwatoko Shugo, Kawamoto Makoto, Komono Akira, Sakamoto Ryohei, Miyasaka Yoshihiro, Higashi Daijiro, Tanabe Hiroshi, Nimura Satoshi, Watanabe Masato
Department of Surgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka, 818-8502, Japan.
Department of Pathology, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushinoshi, Fukuoka, 818-8502, Japan.
Surg Case Rep. 2021 Oct 20;7(1):225. doi: 10.1186/s40792-021-01310-8.
Primary gastric synovial sarcoma is extremely rare, only 44 cases have been reported so far, and there have been no reports of laparoscopic endoscopic cooperative surgery for this condition.
A 45-year-old male patient presented with gastric pain. Esophagogastroduodenoscopy was performed that led to the identification of an 8-mm submucosal tumor in the anterior wall of the antrum, and a kit-negative gastrointestinal stromal tumor was suspected following biopsy. On endoscopic ultrasonography, the boundary of the tumor, mainly composed of the second layer, was depicted as a slightly unclear low-echo region, and a pointless no echo region was scattered inside. A boring biopsy revealed synovial sarcoma. Positron emission tomography did not reveal fluorodeoxyglucose (F-FDG) accumulation in the stomach or other organs. Thus, the patient was diagnosed with a primary gastric synovial sarcoma, and laparoscopic endoscopic cooperative surgery was performed. The tumor of the antrum could not be confirmed laparoscopically from the serosa, and under intraoperative endoscopy, it had delle on the mucosal surface, which was removed by a method that does not involve releasing the gastric wall. Immunohistochemistry showed that the spindle cells were positive for EMA, BCL-2 protein, TLE-1, and SS18-SSX fusion-specific antibodies but negative for KIT and DOG-1. The final pathological diagnosis was synovial sarcoma of the stomach. The postoperative course was good, and the patient was discharged from the hospital on the 11th postoperative day.
Resection with laparoscopic endoscopic cooperative surgery (LECS), which has not been reported before, was effective for small synovial sarcomas that could not be confirmed laparoscopically. With the combination of laparoscopic and endoscopic approaches to neoplasia with a non-exposure technique (CLEAN-NET) procedure, it was possible to excise the tumor with the minimum excision range of the gastric serosa without opening the stomach.
原发性胃滑膜肉瘤极为罕见，迄今为止仅报道了44例，且尚无针对该病症的腹腔镜内镜联合手术的报道。
一名45岁男性患者因胃痛就诊。进行了食管胃十二指肠镜检查，发现胃窦前壁有一个8毫米的黏膜下肿瘤，活检后怀疑为试剂盒阴性的胃肠道间质瘤。在内镜超声检查中，主要由第二层组成的肿瘤边界被描绘为略不清楚的低回声区域，内部散在有无回声区域。穿刺活检显示为滑膜肉瘤。正电子发射断层扫描未显示胃或其他器官有氟脱氧葡萄糖（F-FDG）积聚。因此，该患者被诊断为原发性胃滑膜肉瘤，并进行了腹腔镜内镜联合手术。腹腔镜下从浆膜面无法确认胃窦肿瘤，术中内镜检查发现黏膜表面有凹陷，采用不切开胃壁的方法将其切除。免疫组织化学显示梭形细胞对EMA、BCL-2蛋白、TLE-1和SS18-SSX融合特异性抗体呈阳性，但对KIT和DOG-1呈阴性。最终病理诊断为胃滑膜肉瘤。术后病程良好，患者术后第11天出院。
以前未报道过的腹腔镜内镜联合手术（LECS）切除对于腹腔镜无法确认的小滑膜肉瘤有效。通过腹腔镜和内镜相结合的肿瘤非暴露技术（CLEAN-NET）程序，可以在不打开胃的情况下以最小的胃浆膜切除范围切除肿瘤。
