Ⅰ型早期胃癌に併存した十二指腸乳頭状腺腫の1例

Papillary Adenoma of the Duodenum Accompanied by Early Gastric Cancer, a Case Report

　最近，十二指腸の良性腫瘍については，診断技術の進歩によって，その報告例が増加してきたが，絨毛状構造をもつ乳頭状腺腫は比較的稀である．著者らは幽門輪上に発生した早期胃癌と十二指腸球部に絨毛状構造をもつ乳頭状腺腫が併存した症例を経験したので報告し，若干の文献的考察を加える．

症例

　患　者：70歳　女性　家婦

　主　訴：特になし

　家族歴・生活歴：特記することなし

　既往歴：61歳の時，上腹部腫瘤にて入院精査したが，胃・十二指腸のX線検査でとくに異常は指摘されなかった．

　現病歴：約2年前にたまたま健康診断の目的で胃・十二指腸X線検査をうけ，十二指腸球部に腫瘤陰影があることを指摘された．内視鏡検査で悪性所見は認められず，生検でも組織学的に正常粘膜と診断されたため，放置していた．その後，とくに自覚症状はなかったが，1976年6月に胃検診で再び十二指腸球部の異常を指摘され，精査のため九大第1内科に入院した．

　A 70-year-old female patient was referred to our hospital for the suspected tumors in the duodenal bulb. Although no abnormal physical findings were noted, X-ray examination showed two tumors of the duodenal bulb, which have been confirmed to be adenoma and adenocarcinoma, respectively, on transduodenal fiberscopic biopsy. Gastroduodenectomy was performed.

　The resected specimen showed two different tumors. The one was a broad-based tumor, 2.0×1.5 cm, located on the lesser curvature of the prepyloric region, having an even white surface unassociated with ulceration. The other was a brownish pedunculated polyp, 2.3×2.0 cm, with vllous surface, located on the posterior wall of the duodenum.

　Histologically, the former showed well-differentiated tubular adenocarcinoma, restricted to the mucosa, partly having adenomatous pattern, and the latter was papillary adenoma.

　The occurrence of adenoma is not uncommon in the large intestine, but rare in the duodenum. To our knowledge there has been only one case report of duodenal papillary adenoma accompanied by gastric cancer.