短期間に急速な増大を示した多中心性巨大脂肪肉腫の1例

Abstract

65歳男性.患者は右上腹部痛で近医にて腹部に巨大腫瘤を認められ紹介入院となった.CTでは左腹腔内に20×10cmの, 右後腹膜に12×8cmの多房性solid massを認め, 内部は不均一で脂肪を含む腫瘍であると疑われた.また両腫瘍の連続性はなく多中心性と考えられた.一方, 生検では脂肪肉腫と確定し, 腫瘍摘出術を行った.病理所見より脂肪肉腫(粘液型)と診断され, 術後2週間で全身状態は回復したが, 後腹膜の腫瘍の癒着が強く一部被膜が残存したため, 化学療法・放射線療法を考慮, だがこれは拒否された.経過観察を行なっていたが, 約4ヵ月後には再度腹部緊満を来し, CTにより腹腔内に巨大な腫瘍を認めて摘出術を施行することとなった.摘除重量は8kgであったが, 20日後からは再度腹部緊満を来しCT上で巨大腫瘍を確認, 腫瘍摘出術を施行するも約1ヵ月後に全身状態悪化で死亡となった

We report a case of multifocal liposarcoma that showed rapid growth in a short term. A 65-year-old male was referred from a local doctor to our clinic with the chief complaint of abdominal fullness. Abdominal CT shows two huge tumors in the intraperitoneal and retroperitoneal space, and we diagnosed it as multifocal liposarcoma. Both tumors were resected. The surgical specimens of intraperitoneal and retroperitoneal masses were 20 x 10 cm and 12 x 8 cm in size, and 3.5 kg and 2.8 kg in weight, respectively. Histological diagnosis of both tumors was myxoid liposarcoma. However, the tumor recurred 4 months later, and two additional operations were required because of rapid growth. The patient died at 7 months after the first admission. The clinical outcome of myxoid liposarcoma is known to be better than other histological types, but it is very poor when the tumor appears multifocally.