内視鏡的に切除した十二指腸カルチノイドの1例

Duodenal Carcinoid Tumor Managed by Endoscopic Resection, Report of a Case

要旨　患者は42歳，男性．1987年から胃潰瘍のため近医で治療を受けていた．1992年4月，上部消化管内視鏡検査で十二指腸第2部に粘膜下腫瘍様の隆起性病変を認めた．生検でカルチノイドが疑われたため，同年6月精査目的で当科紹介入院となった．入院時検査成績では内分泌学的異常は認めず，転移の所見は認めなかった．超音波内視鏡検査では腫瘍は粘膜下層に限局しており，内視鏡的切除を施行した．切除標本の病理組織学的検査で，腫瘍は粘膜下層内に限局して発育した径9mmのカルチノイド腫瘍で内視鏡的に完全切除されていると考えられた．切除15か月後の現在，再発・転移は認められていない．本例のような小さなカルチノイド腫瘍は内視鏡的切除が可能であると考えられた．

　A 42-year-old man was referred to our hospital because routine endoscopic examination detected a small submucosal tumor with an irreqularly shaped erythematous depression in the second portion of the duodenum, and the histological features of the biopsy specimen were suggestive of carcinoid tumor. On admission, the patient was in good condition and endocrinological findings were within normal limits. Other examinations indicated no metastasis. Endoscopic ultrasonography demonstrated that the tumor, measuring 9mm in size, was definitely located within the submucosal layer. We therefore performed endoscopic resection. Histological examination of the specimen showed carcinoid tumor in the submucosal layer, which was completely resected. Despite repeated examination including endoscopy and abdominal ultrasonography 15 months later, the patient has revealed no sign of recurrence.