Gastrointestinal stromal tumor(GIST)を合併した右副腎腺腫の1例

Abstract

48歳男性。患者は人間ドックの腹部超音波・内視鏡・CT検査にて胃粘膜下腫瘍および右副腎腫瘍を指摘され, 著者らの施設へ紹介となった。臨床検査では異常所見は認められず, 腹部MRIおよび131I-アドステロールシンチグラフィーにて胃粘膜下腫瘍(GIST)と右副腎腫瘍の合併を考え, 体腔鏡下に胃部分切除および右副腎摘除術が行なわれた。その結果, 病理組織学的に本症例は胃GISTを合併した右副腎腺腫と診断され, 術後10ヵ月経過現在, 再発および転移はみられず, 良好である。

A 48-year-old man was referred to our institute for the evaluation of a concomitant gastric submucosal tumor and right adrenal tumor, incidentally found by ultrasound examination. Computed tomography showed a mass with a diameter of 6 cm adjacent to the stomach and the right adrenal tumor with a diameter of 3 cm. These tumors had similar characteristics in both plain and enhanced imagings. By magnetic resonance imaging, the intensity of the right adrenal tumor was equivalent to the liver in both T1 and T2 weighted images. On the other hand, the gastric submucosal tumor showed low intensity in T1 weighted images and high intensity in T2 weighted images. An adosterol scintigram showed slight accumulation at the region of adrenal tumor. The results of all conducted serum and urinary hormonal examinations were found to be within the normal range. Adrenalectomy and partial gastrectomy were performed laparoscopically. Pathological diagnosis of the adrenal tumor was a cortical adenoma, and that of the gastric submucosal tumor was gastrointestinal stromal tumor (GIST). The gastric tumor was immunohistochemically stained positive with the C-kit and CD34 and negative for s-100 protein and desmin. Histopathological diagnosis was coincident with gastric GIST and right adrenocortical adenoma, and the GIST was diagnosed as a high risk tumor because its diameter was over 5 cm.