直腸原発GIST(gastrointestinal stromal tumor)の2例

直腸原発gastrointestinal stromal tumor(GIST)の2例を経験したので報告する.症例1は44歳男性である.直腸平滑筋肉腫に診断で,腹会陰式直腸切断術(APR)を施行した.補助療法は行わず,術後7年8カ月目にS3肝転移を認め,肝外側区域切除を行い,現在生存中である.症例2は43歳男性である.術中迅速病理診断で直腸平滑筋肉腫の確定診断を得たため,APRを行った.術後2年目に局所再発および多発肝転移を来し,術後4年目には肺転移を認めた.CT下マイクロウェーブ凝固療法,化学療法,TAEで加療を行ったが,術後5年3カ月目に死亡した.両症例に後日免疫組織化学染色を施工し,c-kitおよびCD34が強陽性を示していたことから狭義のGISTと診断された.直腸原発GISTの症例の報告は少ない.本邦における直腸GISTの報告例とともに,若干の文献的考察を加え報告する.Two cases of gastrointestinal stromal tumor (GIST) originating in the rectum are reported. The first patient was a 44-year-old man (Case 1) who underwent abdominoperineal resection (APR) for a diagnosis of smooth muscle sarcoma of the rectum. No adjuvant therapy was administered. Seven years 8 months after the operation, hepatic metastasis (S3 region of the liver) was diagnosed, and excision of the lateral segment of the liver was performed. The patient is alive 5 months after the operation. The second patient was a 43-year-old man (Case 2) with smooth muscle sarcoma of the rectum diagnosed by intraoperative frozen section examination, and APR was performed. Two years after the operation, local recurrence and multiple hepatic metastases were diagnosed. Two years later, metastasis to the lung was diagnosed. The patient was treated by microwave coagulation therapy under CT guidance for local recurrence and TAE for liver metastasis, and systemic chemotherapy, but died 5 years and 3 months after the operation. Immunohistchemical staining of the tumor specimens obtained from these patients revealed that the tumors were strongly c-kit- and CD34-positive, clear evidence for a diagnosis of GIST. Since there have been few reports in the literature of patients with recurrence or metastasis of definite GIST originating in the rectum, we report our two cases of rectal GIST

直腸原発GIST(gastrointestinal stromal tumor)の2例

直腸原発gastrointestinal stromal tumor(GIST)の2例を経験したので報告する.症例1は44歳男性である.直腸平滑筋肉腫に診断で,腹会陰式直腸切断術(APR)を施行した.補助療法は行わず,術後7年8カ月目にS3肝転移を認め,肝外側区域切除を行い,現在生存中である.症例2は43歳男性である.術中迅速病理診断で直腸平滑筋肉腫の確定診断を得たため,APRを行った.術後2年目に局所再発および多発肝転移を来し,術後4年目には肺転移を認めた.CT下マイクロウェーブ凝固療法,化学療法,TAEで加療を行ったが,術後5年3カ月目に死亡した.両症例に後日免疫組織化学染色を施工し,c-kitおよびCD34が強陽性を示していたことから狭義のGISTと診断された.直腸原発GISTの症例の報告は少ない.本邦における直腸GISTの報告例とともに,若干の文献的考察を加え報告する.Two cases of gastrointestinal stromal tumor (GIST) originating in the rectum are reported. The first patient was a 44-year-old man (Case 1) who underwent abdominoperineal resection (APR) for a diagnosis of smooth muscle sarcoma of the rectum. No adjuvant therapy was administered. Seven years 8 months after the operation, hepatic metastasis (S3 region of the liver) was diagnosed, and excision of the lateral segment of the liver was performed. The patient is alive 5 months after the operation. The second patient was a 43-year-old man (Case 2) with smooth muscle sarcoma of the rectum diagnosed by intraoperative frozen section examination, and APR was performed. Two years after the operation, local recurrence and multiple hepatic metastases were diagnosed. Two years later, metastasis to the lung was diagnosed. The patient was treated by microwave coagulation therapy under CT guidance for local recurrence and TAE for liver metastasis, and systemic chemotherapy, but died 5 years and 3 months after the operation. Immunohistchemical staining of the tumor specimens obtained from these patients revealed that the tumors were strongly c-kit- and CD34-positive, clear evidence for a diagnosis of GIST. Since there have been few reports in the literature of patients with recurrence or metastasis of definite GIST originating in the rectum, we report our two cases of rectal GIST