十二指腸球部カルチノイド腫瘍によるZollinger-Ellison症候群の1例

Zollinger-Ellison Syndrome Caused by a Duodenal Carcinoid Tumor

　Zollinger-Ellison症候群（以下ZESと略す）は1955年のZollingerとEllisonの報告以来，欧米では1,000例を越す症例が集積されている¹⁾．しかし，本邦報告例は100余例にすぎず，その臨床像も未検討の部分が多い．最近，われわれはその特異なX線・内視鏡像が診断のきっかけとなり，十二指腸球部のカルチノイド腫瘍が原発巣と考えられたZESの1例を経験したので報告する．

　A 65-year-old man was admitted to our hospital in July 1978 with complaints of epigastralgia of hunger state and melana for eight years. Past history revealed that he had two operations before. His first operation was performed for Ⅱc and Ⅲ type early gastric cancer and a carcinoid tumor of the duodenal bulb in April 1970. At this time no liver metastasis was recognized. But the symptomes persisted and stomal ulcers were found. His second gastrectomy done in July 1974 also was followed by anastomotic ulcers and could not relieve his pains.

　Physical examination and routine laboratory study were not contributory to the diagnosis. Upper gastroduointestinal series and fiberscopy revealed two stomal ulcers and multiple erosions of the jejunum. Gastric acid analysis showed that basal acid output was 7.8mEq/hr and maximal acid output by secretin stimulation 10.0mEq/hr. Serum gastrin level was 208pg/ml in fasting state. Abnormal serum gastrin increase in secretin and calcium infusion test fulfilled the criteria of the Zollinger-Ellison syndrome. Serum secretin, VIP, PTH and urinary 5-HIAA were not increased. Multiple liver metastases were confirmed by abdominal angiogram.

　In December 1978 total gastrectomy and partial pancreatectomy were performed. Liver biopsy specimens were compatible to the metastatic carcinoid tumors histologically. Grimelius staining was positive. We were able to demonstrate a number of gastrin cells in liver biopsy specimens and the paraffinized specimens of the duodenal carcinoid tumor by immunoperoxidase staining method. Tissue extracts from the liver specimens were found to contain 38,000ng of gastrin per gram wet tissue.

　The patient is getting very well after the third operation.