腹腔鏡下切除術を行った卵巣腫瘍と鑑別が困難であった静脈外膜嚢腫
| Jazyk: | angličtina |
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| Rok vydání: | 2020 |
| Předmět: | |
| Zdroj: | 産業医科大学雑誌 = Journl of UOEH. 42(1):51-55 |
| Popis: | Adventitial cystic disease (ACD) is a rare condition in which a mucinous cyst forms within the adventitia, usually in arteries but rarely in veins. A 79-year-old patient presented with stomachache and nausea. Computerized tomography showed pelvic cysts on either side of the pelvis. The right tumor was 120×100 mm, and the left tumor was 45×35 mm. Our diagnosis was bilateral ovarian tumors and we performed laparoscopic tumor resection. In the abdominal cavity, we saw that the left ovary was swollen by about 3–4 cm and the right ovary was normal size. There was a mucous cyst located in the right retroperitoneal cavity that adhered around and bordered the right external iliac vein and the right obturator nerve. We peeled the adhesion away carefully and resected the tumor but the operation caused temporary obturator nerve paralysis. From pathological examination, we diagnosed the right retroperitoneal cyst to be venous ACD originating from the right external iliac vein. We found that venous ACD can grow as large as a pelvic tumor and is difficult to distinguish from an ovarian tumor, which is why we chose laparoscopic surgery. In this case, we performed the operation laparoscopically and no sequelae or recurrent tumor appeared during a 1-year follow-up. However, graft replacement is sometimes necessary for ACD, thus venous ACD should be considered a differential diagnosis and a surgical strategy should be developed when pelvic tumors are observed. 血管外膜嚢腫は，血管外膜内に粘液性嚢胞を形成する珍しい疾患である．主に動脈に発生するが，静脈内発生は稀である．今回，卵巣腫瘍と鑑別が困難であった静脈外膜嚢腫の1例を経験した．症例は79歳の女性，腹痛と吐き気を主訴に来院した．コンピューター断層撮影（CT）では，右側に120 × 100 mm，左側に45 × 35 mm大の両側性の骨盤内嚢胞を認めた．両側性卵巣腫瘍の診断で，腹腔鏡下腫瘍切除術を行う方針となった．腹腔内を観察すると，左卵巣は約3〜4 cmに腫大していたが右卵巣は正常外観であった．右後腹膜腔に外腸骨静脈と閉鎖神経に強固に癒着した粘膜性嚢胞を認めた．注意深く癒着を剥離し腫瘍を切除したが，術後に一時的な閉鎖神経麻痺を来した．術後の病理学的検査から，右外腸骨静脈に由来する静脈外膜嚢腫の診断となった．術後1年間経過したが，再発なく経過している．静脈外膜嚢腫は，骨盤内腫瘍として発育することがあり卵巣腫瘍と鑑別を要する．本症例では腹腔鏡下手術が選択されたが，再発を防ぐためには腫瘍の完全切除が必要であり，人工血管置換術が必要となる場合もある．骨盤内嚢胞性病変の鑑別疾患として血管外膜嚢腫を念頭に置くことが重要であると考えられた． |
| Databáze: | OpenAIRE |
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