抄録
Small intestinal fiberscopy and endoscopic biopsy was effective for definitive diagnosis in a case with leiomyosarcoma of the upper jejunum. A 38 year-old man was admitted on October 13, 1976, to our hospital because of abdominal pain for several months duration. There was a firm mass of 8×7 cm in its size with slight tenderness in his hypochondrium. Laboratory data on admission revealed acute inflammation and positive occult blood of stool. Routine upper G. I, series, gastro-duodenoscopy, hepatic scintigraphy, barium enema, endoscopic retrograde pancreatography and 67 Ga scintigraphy gave no positive findings. Small bowel radiography with double contrast method showed a small barium fleeck in the proximal portion of the jejunum; extravasation and pooling of contrast medium into extra-canalicular mass was also seen. Selective celiac and superior mesenteric arteriography revealed a large number of tumor vessels in arterial phase and apparent tumor stain in venous phase. On endoscopic examination with small intestinal fiberscope (SIF-B, Olympus), submucosal tumor with central ulceration was observed at the beginning part of the jejunum. A biopsy specimen which was obtained from the ulcer margin revealed myogenic tumor. About 7.5×6×5cm sized mass with cavity in its center was resected from the proximal part of the jejunum (about 5cm from the Lig. of Treitz). Several metastatic lesions were found on the liver surface during the operation. The tumor was confirmed as leio. myosarcoma of the jejunum histologically. This case might be the first to be diagnosed as jejunal leiomyosarcoma with endoscopic observation and biopsy, although several cases of small intestinal carcinoma and lymphoma diagnosed with endoscopy have been reported.
