中部小腸に発生したカルチノイド腫瘍の1例

Carcinoid Tumor Occuring in the Middle Portion of Small Intestine, Report of a Case

要旨　患者は71歳，男性．約12年前より間欠的に腹痛を繰り返すため当院を受診した．経口小腸X線検査では中部小腸に口側腸管の拡張を伴う狭窄を認めた．ゾンデ法小腸X線検査では，狭窄部に一致して辺縁平滑な陰影欠損，偏側性の硬化像，および狭窄部の不整陰影斑を認めた．小腸腫瘍の診断下に開腹手術を行ったところ，術中内視鏡検査で上記X線所見に合致する所見が得られた．病理組織学的には腸間膜根部のリンパ節転移を伴う回腸カルチノイド腫瘍で漿膜下に浸潤していた．本邦では，カルチノイド腫瘍が中部小腸に発生することはまれと考えられるが，自験例はゾンデ法小腸X線検査と術中内視鏡検査でカルチノイドの所見を確認しえた貴重な症例と考えられた．

　A 71-year-old man was referred to our hospital complaining of intermittent abdominal pain. Barium meal study revealed a narrowing in the middle portion of the small intestine. Double-contrast radiography demonstrated a filling defect with smooth contour, wall rigid-ity, and an irregular-shaped barium fleck. The findings of intra-operative enteroscopy were consistent with those of the radiographic examination. Surgical resection was performed, and the tumor was histologically diagnosed as an ileal carcinoid. The tumor had invaded the subserosal layer and had metastasis to lymphnodes of the mesenterium. Because a carcinoid tumor occurring in the middle portion of the small intestine is rare in Japan, findings of the radiographic and endoscopic examinations of our case were compared and discussed.