生検で消失したと考えられる十二指腸カルチノイドの1例

Carcinoid Tumor of the Duodenal Bulb Completely Removed by Endoscopic Biopsy, Report of a Case

要旨　患者は59歳，女性．1981年3月上腹部不快感を主訴に来院し，X線，内視鏡検査で十二指腸球部小彎前壁寄りに径5mm大の粘膜下腫瘤様隆起を認め，生検でカルチノイドと診断された．入院後のX線，内視鏡検査では明らかな隆起は球部に認められず，隆起が存在したと思われる部位より計2回の生検を施行したがカルチノイドの組織は得られなかった．その後，外来で1～2年に1回の割でX線，内視鏡検査による経過観察が行われたが，1989年3月現在カルチノイドの再発は認められず，初回生検によって完全に消失したものと考えられた．

　A 59-year-old woman was referred to us for the excision of a carcinoid tumor of the duodenum in April, 1981. One month prior to hospitalization, she was evaluated at Karatsu Gastric Institute because of upper abdominal discomfort. A small (5 mm in diameter) polypoid lesion was found in the duodenal bulb on upper gastrointestinal series (Fig. 2). With the review of upper gastrointestinal series in the past, a small polypoid lesion was already present in April, 1972 at the same site of the duodenal bulb (Fig. 1).

　Initial endoscopy performed at Karatsu Gastric Institute in March, 1981 revealed a small sessile polyp with overlying normal mucosa in the duodenal bulb (Fig. 3). Histological examination of the biopsy specimen obtained from the lesion disclosed a carcinoid tumor (Fig. 5). On admission she was in good general condition.

　Physical examination was unremarkable. Laboratory data were almost within normal limits. Urine 5-HIAA and serum serotonin levels were also within normal limits (Table 1). Upper gastrointestinal series and gastroduodenoscopy performed after admission revealed no polypoid lesion in the duodenal bulb (Figs. 4 and 5). Repeated endoscopic biopsies from the duodenal bulb showed no carcinoid tumor.

　It was considered that the carcinoid tumor was completely removed by the initial endoscopic biopsy. The patient has been followed for 8 years without any evidence of recurrence or metastatic spread of the carcinoid tumor (Figs. 7 and 8).