巨大Brunner腺腫の1例

Giant Brunner's Gland Hyperplasia in the Duodenal Bulb, Report of a Case

要旨　患者は76歳，女性．全身倦怠感と胸痛を主訴として近医に入院した．高度の貧血を指摘され，諸検査にて出血性十二指腸腫瘍の診断で当科へ転院した．上部消化管X線および内視鏡検査により球部前壁に基部をもつ6×3cm大の有茎性ポリープと診断された．血管造影では豊富な腫瘍血管が描出され，腹腔鏡でも十二指腸前壁漿膜に拡張した腫瘍血管の集中が観察された．腫瘍の大きさおよび出血の可能性も考慮し，外科的切除を行った．摘出標本は6.5×3×2.5cmの粗大結節状の軟らかい腫瘍で，組織学的に異型のないBrunner腺房の過形成から成っていた．以上から巨大Brunner腺腫と診断した．腺腫基部には血管造影所見に一致する豊富な血管組織が認められた．

　A 76-year-old woman with a hyperplastic polyp of Brunner's gland in the duodenum is reported. She presented to us with complaints of general fatigue and chest pain due to severe anemia (Hb 4.8g/dl). Upper gastrointestinal x-ray and endoscopic examinations showed a large pedunculated polyp in the duodenal bulb. Angiography of the common hepatic artery revealed well-developed tumor vessels arising from the superior duodenal artery. Under laparoscopy, a serosal pit with abundant dilated vessels was observed at the anterior wall of the duodenum, and the polyp was laparoscopically resected after ligating the stalk with two loops. However, the loop ligatures were slipped off, and subsequent laparotomy and surgical closure were performed immediately. The polyp was 6.5×3.0×2.5 cm in size and microscopically demonstrated a hamartoma of Brunner's gland with gastric epithelium.