胃・十二指腸に早期癌を認めた家族性大腸腺腫症の1例

Familial Adenomatous Polyposis Associated with Early Gastric Cancer and Early Duodenal Cancer, Report of a Case

要旨　患者は41歳，男性．高校時代から排便時にときどき出血があったが，痔核のためと思い放置していた．1993年8月，近医で貧血を指摘され当院受診．注腸造影と大腸内視鏡検査で大腸腺腫症と診断され，当科に入院した．精査によりⅡc型早期胃癌，多発性胃腺腫，早期十二指腸癌，多発性十二指腸腺腫，回腸腺腫，直腸癌，下顎骨腫，腹壁脂肪腫を合併していた．大腸全摘・回腸瘻造設術，3/4胃切除術，十二指腸ポリープ切除術，胆囊切除術，腹壁腫瘤摘出術を施行した．胃・十二指腸に同時に早期癌を合併した症例はわが国で最初と思われる．わが国における胃癌合併例および十二指腸癌合併例の集計結果と併せて報告した．

　A 41-year-old man was referred to our hospital because of anemia and anal bleeding. The diagnosis of adenomatosis coli was made on the basis the findings of barium enema study. Further examinations revealed complications of Ⅱc-type early gastric cancer, gastric adenomas, early duodenal cancer, duodenal adenomas, rectal cancer, osteoma in the submandibular bone and lipoma in the abdominal wall. Total proctocolectomy and ileostomy, 3/4 partial gastrectomy, surgical polypectomy of the duodenal polyp, and enucleation of lipoma in the abdominal wall were performed. It is considered that this case is the first one of familial adenomatous polyposis associated with both gastric cancer and duodenal cancer in Japan. In the present report, the authors reviewed Japanese literature cases of familial adenomatous polyposis complicated by gastric and duodenal cancer, and discussed their clinical features.