経時的な形態変化を観察しえた胃血管肉腫の1例

症例は71 歳男性．肝障害の精査目的で施行した全身CT 検査で境界明瞭な類円形の肺結節影を２カ所指摘され，転移性肺腫瘍が疑われた．原発巣検索として施行した上部消化管内視鏡検査で，胃体部大彎に発赤調の扁平隆起性病変を認めた．病理組織検査でERG・CD31 が陽性となる異型細胞を認め，胃血管肉腫と診断した．Paclitaxel による化学療法を行い一旦縮小したが，その後再増大し，紫紅色の２型腫瘍様の形態を呈した．診断から11 カ月後に全身状態の悪化，消化管出血により永眠した．消化管に発生する血管肉腫は原発性，転移性ともに非常に稀であり，本症例は内視鏡で経時的な形態変化を観察しえた貴重な症例と考えられた．

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We report a case of a 71-year-old man with gastric angiosarcoma. Two round lung tumors were found accidentally on chest CT performed as part of an examination for abnormal liver function. These tumors appeared to be metastatic. Esophagogastroduodenoscopy revealed a red flat, slightly elevated mass in the greater curvature of stomach. Pathological examination of biopsied stomach tissues revealed proliferation of malignant cells. Immunostaining were positive for ERG and CD31. Based on these findings, the patient was diagnosed as having gastric angiosarcoma with lung metastases. The gastric and lung tumor masses diminished in size with the application of chemotherapy with paclitaxel. However, after seven chemotherapy courses, the gastric tumor enlarged and had a purplish-red type 2 tumor-like appearance. Therefore, we changed the chemotherapy regimens; however, it was ineffective. The patient died of serious bleeding in the digestive duct 11 months after the first visit. We encountered a rare case of angiosarcoma in the stomach with multiple distant metastases and found morphological changes in the tumor on conducting esophagogastroduodenoscopy. Further progress in the early diagnosis and treatment of angiosarcoma is needed to improve the prognosis of the affected patients.

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en : 日本消化器内視鏡学会雑誌

巻 65, 号 10, p. 2180-2186, 発行年 2023-10-20

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0387-1207

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2025-02-19 05:35:35.217586

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