尾本 きよか^{1, 2}, 松本 廣嗣³, 大城 潔⁴, 高良 博明⁴, 慶田 喜秀², 菊地 馨², 金城 盛男²

Kiyoka OMOTO^{1, 2}, Hiroshi MATSUMOTO³, Kiyoshi OOSHIRO⁴, Hiroaki TAKARA⁴, Yoshihide KEIDA², Kaoru KIKUCHI², Morio KINJYOH²

¹自治医科大学附属病院臨床病理部, ²沖縄県立中部病院消化器内科, ³沖縄県立中部病院外科, ⁴沖縄県立中部病院放射線科

¹Department of Clinical Pathology, Jichi Medical School, ²Department of Gastroenterology, Okinawa Chubu Hospital, ³Department of Surgery, Okinawa Chubu Hospital, ⁴Department of Radiology, Okinawa Chubu Hospital

キーワード : Hemangioma, Mesenteric tumor, Ultrasonography

A 35 year-old woman was hospitalized because of melena and anemia. Physical examination showed anemic conjunctiva. No palpable mass was found in the abdomen. Peripheral blood analysis showed iron deficiency anemia. Occult blood was noted in the stool. Results of gastroendoscopy and colonoscopy were normal. A small-bowel follow-through examination showed compression and distention of the jejunum, and multiple small elevated lesions were observed in the lumen of the jejunum. Tc-99m labeled RBC scintigraphy at 24 hours demonstrated abnormal uptake superior to the urinary bladder. Abdominal ultrasonography showed a heterogeneous tumor 10 cm in diameter. It was composed of multiple hypoechoic nodules that measured 2 to 20 mm across. On the other hand, cystic lesions were observed at the edge of the tumor, and they changed the shape on compression. Because mesenteric vessels ran through it, the tumor was thought to be of mesenteric origin. Surgery showed an 11×8 cm tumor in the mesentery partially involving the distal jejunum. It was dark red with an irregular surface and was made up of multiple cystic lesions filled with coagulated blood. One of several polypoid lesions were found at the jejunal lumen was bleeding. The pathological diagnosis was cavernous hemangioma with partially dilated lymphatic vessels. We believe that the tumor appeared hypoechoic rather than cystic sonographically because the pooling blood in the hemangioma was almost completely coagulated.