異所性胃粘膜から発生した一部に癌巣を伴った十二指腸腺腫の1例

Adenoma with Focal Carcinoma of the Duodenal Bulb Arising from Heterotopic Gastric Glands, Report of a Case

要旨　患者は67歳，男性．狭心症にて通院中，検診目的で上部消化管内視鏡検査を施行した．十二指腸球部前壁に亜有茎性隆起性病変を認め，生検で腺腫と診断され内視鏡的粘膜切除術を行った．病理組織学的には，腫瘍組織は表層にGOCTS染色陽性の腺窩上皮と深層にPCS染色陽性のIII型粘液腺を認め，胃の腺窩上皮と幽門腺への分化形質を有し，一部に癌巣を伴った腺腫と診断された．腫瘍辺縁部には異型性の乏しい腺窩上皮と主細胞・副細胞から成る胃底腺を認めた．腫瘍は十二指腸の異所性胃粘膜から発生したものと考えられた．

　A 67-year-old man who had angina pectoris underwent endoscopic examination during a health check-up. Endoscopic examination with biopsy revealed an adenoma on the anterior wall of the duodenal bulb. Endoscopic mucosectomy was performed.

　Histological findings showed that the tumor was composed of mucous cells containing paradoxical concanavalin A-class III positive mucine and surface mucous cells containing galactose oxidase-cold thionin Schiff positive mucine. The adenoma with focal carcinoma consisted of gastric-type foveolar epithelium and pyrolic glands, which suggested gastric differentiation. Heterotopic gastric glands with no evidence of cytologic or histologic atypia were able to be seen at a peripheral lesion of the mucosal layer. We concluded that the duodenal adenoma with focal carcinoma had arisen from heterotopic gastric mucoua.