早期胃癌と食道粘膜異形成症を合併し，早期腺癌および腺カルチノイド（adenocarcinoid）を伴った十二指腸腺腫の1例

Duodenal Adenoma Accompanied with an Early Adenocarcinoma and Adenocarcinoid in Combination with an Early Gastric Cancer and Esophageal Mucosal Dysplasia, Report of a Case

要旨　77歳，男性の十二指腸球部にポリープ状病変が発見され，組織学的に腺管絨毛腺腫が示唆された．約1年後，食道中部に多結節性病変が発見され，生検で粘膜異形成症が確認された．以後厳密に追跡したが，両病変は変化しなかった．十二指腸病変の発見後約5年目（82歳時）に，その部分的ポリペクトミー組織検査により，腺管絨毛腺腫に高分化腺癌と腺カルチノイドの合併を認めた．また胃体部後壁に軽い周囲隆起を伴う小平坦病変がみられ，生検で腺管腺腫を示した．切除標本の組織検索で球部腺腫直下の粘膜筋板から粘膜下層深部にかけ腺カルチノイドの限局浸潤が確認され，所属リンパ節転移を伴っていた．胃病変は高分化型管状腺癌から成るIIc+IIb型m癌で，残存腺腫は周辺に限られていた．

　A 77-year-old patient was found to have a polypoid lesion in the duodenal bulbus the histology of which suggested a tubulo-villous adenoma. About one year later, a flat multi-nodular lesion was detected in the middle esophagus, which was confirmed histologically as a mucosal dysplasia. Both lesions were followed up carefully, but showed no significant changes.

　About five years after the discovery of the duodenal lesion, when the patient was 82-year-old, histology of its partial polypectomy revealed that the adenoma was associated with small foci of well-differentiated adenocarcinoma as well as adenocarcinoid. At this time a small flat lesion with a slight marginal swelling was found situated at the posterior wall of the gastric body and its biopsy revealed a typical tubular adenoma. Histological study of the resected specimen disclosed that the foci of the adenocarcinoid associated with the bulbar adenoma had invaded from the muscularis mucosae to the deep submucosal layer and metastasized to the regional lymph node. The gastric lesion was found to consist of a small early cancer of type IIc+IIb with intramucosal invasion by a well-differentiated tubular adenocarcinoma in which adenoma-residues remained minimal.