十二指腸悪性腫瘍の内視鏡診断

Endoscopic Diagnosis of Malignant Lesions of the Duodenum

要旨　1971年から1991年の21年間に経験した十二指腸悪性病変128例の内視鏡像，診断経過などから，診断，殊に質的診断における問題点の所在あるいは今後の対応などについて検討した．膵癌の直接浸潤や肺癌の転移など転移浸潤性病変の場合，悪性の診断は容易であった．乳頭部以外の原発性十二指腸癌10例中，進行癌8例は膵癌の直接浸潤との鑑別が問題となり，早期癌の発見には良性病変との鑑別や腺腫内癌に対する確実な診断が必要であった．腺腫のうち，家族性大腸ポリポーシス合併例の1例は4年8ヶ月の経過で1/3周性の巨大な病変になったが，切除材料でも癌巣は認められず，腺腫のまま大型化する病変の存在が推察された．またカルチノイドの肉眼診断は困難で生検診断に頼らざるをえなかった．

　We experienced 128 cases of duodenal malignant lesions during the period between 1971 and 1991. In 56 cases of secondary duodenal malignant lesions such as direct invasion of pancreatic carcinoma, differentiation between benign and malignant lesions was quite easy. There were 10 cases of primary duodenal carcinoma except for carcinoma of the ampulla of Vater. In 8 advanted cases, direct invasion of pancreatic cancer needed to be excluded. One early cancer of a small, 7×3 mm in size, polypoid lesion was found endoscopically in the bulb. The other early cancers were intramucosal carcinomas associated with adenoma. We also had 17 cases of pathologically-proved duodenal adenoma. A lesion in a patient with familial polyposis coli had grow from a small whitish spot to a large protrusion, a third of the circumference in size, in 4 years and 8 months, but no malignant change was detected in the resected specimen. It was almost impossible to distinguish a small carcinoid from a benign elevated lesion in the duodenom, and biopsy was considered to be the only method to detect such a small malignant lesion.