十二指腸球部癌と胃癌の重複癌症例

Double Cancer Involving the Doudenal Bulb and the Stomach, Report of a Case

要旨　患者は68歳女性で主訴は食欲不振．上部消化管X線検査および内視鏡検査で胃体部小轡の不整形の陥凹性病変と球部に隆起性病変の2つの病巣を認めた．生検によりいずれも悪性所見が得られ手術を施行した．胃病変は深達度seの印環細胞癌でlinitis plastica様の粘膜下浸潤を来していた．十二指腸病変は高分化型管状腺癌で深達度はseであった．非常にまれな胃および十二指腸球部の重複癌を報告した．

　A 68-year-old woman was admitted to our hospital complaining of anorexia and vomiting. The x-ray and endoscopic examinations of the upper gastrointestinal tract demonstrated an irregular-shaped, depressed lesion in the gastric body and a polypoid lesion in the anterior wall of the doudenal bulb. Biopsy of these lesions led us to make a diagnosis of double cancer involving the doudenal bulb and the stomach. Subtotal gastrectomy, partial duodenetomy and lymph node dissection were performed. Histologically the gastric lesion was signet-ring cell carcinoma which invaded diffusely reaching to the serosal surface, while the duodenal lesion was well differentiated tubular adenocarcinoma which also invaded to the serosal surface.

　Double cancer involving the stomach and the duodenum (excluding the papilla of Vater) is very rare and only 4 cases have been reported so far in Japan.