石田 誠¹, 岩田 康義¹, 稲田 俊雄¹, 塩見 勝彦¹, 吉永 浩明¹, 菅 敬彦¹, 中村 之信¹, 児島 完治², 呉羽 晃徳³, 溝渕 光一⁴

Makoto ISHIDA¹, Yasuyoshi IWATA¹, Toshio INADA¹, Katsuhiko SHIOMI¹, Hiroaki YOSHINAGA¹, Toshihiko KAN¹, Yukinobu NAKAMURA¹, Kanji KOJIMA², Akinori KUREHA³, Kohichi MIZOBUCHI⁴

¹香川労災病院内科, ²香川労災病院放射線科, ³香川労災病院臨床検査部, ⁴香川労災病院病理科

¹Department of Internal Medicine, Kagawa Rosai Hospital, ²Department of Radiology, Kagawa Rosai Hospital, ³Department of Clinical Laboratory, Kagawa Rosai Hospital, ⁴Department of Pathology, Kagawa Rosai Hospital

キーワード : CT, Malignant leiomyoblastoma, Pseudo-kidney sign, Small intestine, Ultrasound

We encountered a rare case of malignant jejunal leiomyoblastoma with a pseudo-kidney sign in a 46-year-old man who visited our institution because of upper abdominal discomfort and anemia. He had previously had cervical lymphadenopathy, which had metastasized from malignant leiomyoblastoma that was proven by lymph-node biopsy. The abdominal echogram showed a tumor with a diameter of about 12×7 cm, a so-called pseudo-kidney sign, consisting of a thickened low-echoic wall that measured about 3 cm across and an internal heterogeneous high-echoic area. Barium examination showed a tumor about 14 cm long with irregular intestinal mucosa 20 cm distal from the ligament of Treiz. CT scan demonstrated marked thickening of the intestinal wall, similar to that of carcinoma of gastrointestinal tract. The tumor was resected because of intestinal bleeding and was found to be soft and fragile. A specimen of the tumor showed expansive growth around the jejunal wall, but the intestinal lumen was maintained. This rare pattern of growth for an intestinal leiomyogenic tumor would appear to explain the appearance of the pseudo-kidney sign in this case.