ダイモウ ゲンパツ キョダイ GIST 1セツジョレイ

We report a case of giant gastrointestinal stromal tumor（GIST）primarily occurred in the greater omentum. A７８-year-old woman was referred to our hospital because of a giant abdominal tumor. Contrast-enhanced abdominal computed tomography（CT）showed a giant tumor measuring ２０×２４×１３cm in diameter in the abdominal cavity, consisting of heterogeneously enhanced solid and cystic lesions. Abdominal magnetic resonance imaging（MRI）after ３ weeks from the first medical examination showed the enlarged tumor measuring２４×２５×１７cm in diameter, the intensity of the solid lesion was low on T１weighted image, heterogeneously enhanced on T２weighted image and high on diffusion weighted image. At surgery, we confirmed the giant tumor continued to the omentum, and pressured the stomach, pancreas, and colon. The resected specimen weighed ８，３２５g containing of５，６４０ml of red-brown fluid. Histological examination showed the tumor consisted of proliferated spindle cells in a fascicular pattern and polynesic hemorrhage and necrosis. Immunohistochemically, the tumor cells were positive for c-kit and CD３４, and negative for S‐１００ protein and desmin, indicating a GIST in the greater omentum. The mitotic figures were in a４０／５０ high power field. In genetic testing, the tumor cells had exon１１mutation of c-kit gene. The woman started taking imatinib after operation and remains alive and recurrence-free

タンカンナイ シュヨウセン オ ミトメ ゲンパツセイ カンナイ タンカンガン トノ カンベツ オ ヨウシタ イジセイ ダイチョウガン カンテンイ ノ 1セツジョレイ

The patient was a 68-year-old man who had undergone right hemicolectomy for ascending colon cancer, and pulmonary resection for lung metastases. After 10 months of operations, abdominal computed tomograms revealed a liver tumor with a biliary tumor thrombus in the segment 5 and a localized dilation of the intrahepatic bile duct. Endoscopic retrograde cholangiopancreatography showed obstruction, 2cm long, of the intrahepatic bile duct （B5） and dilation of the peripheral duct. Cytological examination of extracted bile showed adenocarcinoma. A right hepatic lobectomy was performed under the diagnosis of metastatic liver tumor with tumor development in the intrahepatic bile duct or intrahepatic cholangiocarcinoma. The resected specimen showed massive infiltration of the tumor into intrahepatic bile duct （B5） with forming a tumor thrombus. Histologically, the tumor was moderately differentiated adenocarcinoma, similar to the ascending colon cancer. The final diagnosis was liver metastasis of ascending colon cancer with intrabiliary tumor growth