十二指腸下行部に多発した陥凹型m癌の1例

Multiple Primary Superficial Depressed Type Intramucosal Carcinoma of the Third Portion of the Duodenum, Report of a Case

要旨　十二指腸下行部に多発する陥凹型早期癌を経験したので報告する．患者は65歳，男性．めまいのため人間ドックを希望し，上部消化管内視鏡検査にて，十二指腸下行部に陥凹性病変を1個発見された．精検にて十二指腸下行部の副乳頭と乳頭間の前壁と，乳頭の約3cm肛門側の前壁の2か所に陥凹性病変を認め，生検にて高分化型管状腺癌と診断された．術中内視鏡にて2病変の位置を確認し，それぞれ紡錘状に部分切除した．切除標本は2病変とも浅い陥凹性病変で，組織所見は粘膜内に限局した高分化型管状腺癌であった．本例は極めてまれであると共に，上部消化管内視鏡検査時の十二指腸観察の必要性を示唆している．

　A 65-year-old man who had vertigo was pointed out to have a superficial depressed lesion in the third portion of the duodenum by routine upper gastrointestinal endoscopy. Further endoscopic examination revealed another similar lesion at 3 cm anal side from the lesion. Both of them proved to be adenocarcinoma by biopsy. Partial resection of the duodenum was performed. Resected specimens showed two superficial depressed small lesions. Histologically, these lesions were well differentiated tubular adenocarcinoma and cancer cells were limited within the mucosal layer. Multiple depressed intramucosal cancer of the duodenum is extremely rare. This case suggests that observation of the duodenum by routine gastrofiberscopy is necessary to detect superficial duodenal cancer.