原発性十二指腸癌の1例

Primary Carcinoma of the Duodenum, Report of a Case

　原発性十二指腸癌は比較的稀な疾患であるが，最近その報告例は増加している．しかし，その大部分は乳頭部周囲癌で，乳頭上部，乳頭下部癌は少ない．また，組織学的には，他の部位の腸の癌と同様に円柱上皮細胞を主とする腺癌が大部分を占めている．

　われわれは，乳頭上部に発生し，carcinoidの疑われる組織像を呈した原発性十二指腸癌の症例を経験したので報告する．

　This is a report of a rare case of un-differentiated adenocarcinoma of the duodenum. The patient, a 57 years-old man was referred to the Ôgaki Municipal Hospital in September, 1976, because of upper abdominal pain. Upper gastrointestinal roentgenograms showed irregular filling defect of the second portion of the duodenum and normal papilla of Vater. Upper gastrointestinal endoscopy perfomed with an Olympus JF-B Ⅱ revealed irregular ulceration with dish-like tumor and stricture at the second portion of the duodenum. An un-differentiated adenocarcinoma of the duodenum or polymorphocellular carcinoma of the pancreas was suspected by the biopsy. But, pancreatic carcinoma was ruled out by normal pancreatogram. This lesion was resectable by pancreatico-duodenectomy. The size of the tumor was 4.5×6.0 cm. Microscopically, the cellular pattern suggested an un-differentiated adenocarcinoma or a carcinod. However, the tumor cells were negative for Grimelius' reaction and secretory granules in the cytoplasma of the tumor cells were not observed by electronmicroscopic examination. Therefore, it was determined as an un-differentiated adenocarcinoma of the duodenum.