内視鏡切除を施行したgangliocytic paragangliomaの1例

Duodenal Gangliocytic Paraganglioma Resected by Endoscopy, Report of a Case

要旨　患者は51歳，男性．検診にて十二指腸の粘膜下腫瘍様隆起を指摘された．上部消化管内視鏡検査では十二指腸膨大部領域に大きさ約30mmの表面平滑な粘膜下腫瘍を認め，EUSでは粘膜下層の低エコーで一部にcysticな部分の混在する粘膜下腫瘍として描出された．腹部CT上明らかな転移は認めず，十二指腸粘膜下腫瘍の診断で，留置スネアを併用した内視鏡的切除を施行した．病理組織学的所見によりgangliocytic paragangliomaと診断された．十二指腸下行脚，膨大部領域に粘膜下腫瘍を認め，EUSにて内部にcysticな部分を有する場合には，gangliocytic paragangliomaも念頭に置くことが重要である．本疾患は基本的には良性疾患であり，可能な限り内視鏡治療を含めた低侵襲な治療を行うことが重要である．

　A 51-year-old man was adimitted to our hospital because of a duodenal submucosal tumor found during a regular medical checkup. Upper gastrointestinal endoscopy revealed a 30-mm sized submucosal tumor located just below the major vater of the duodenal 2nd portion. Endoscopic ultrasonography showed the hypoechoic tumor located in the submucosa with cystic lesions. No metastatic lesion was delineated by an abdominal CT scan. Endoscopic polypectomy using a loop snare was performed without any complications. The tumor was histologically diagnosed as a gangliocytic paraganglioma. It is clinically important to recognize that a submucosal tumor may be a gangliocytic paraganglioma if the submucosal tumor is located near the ampullary region and is visualized with cystic compornents by EUS. Because gangliocytic paraganglioma is generally a benign tumor, it is important that the tumor should be resected in a less invasive fashion such as endoscopic resection.