十二指腸カルチノイドの1例

Duodenal Carcinoid, a Case Report

　本邦における消化管カルチノイドの報告例は，近年次第に増加し，阿部¹⁾によれば110例に達する．このうち十二指腸カルチノイドは9例であるが，筆者らの集計したところでは，自験例を含めて15例であった．昨年筆者らは，良性の十二指腸カルチノイドの1例を経験したので，若干の文献的考察を加えて報告する．

　A woman 62 years of age visited our hospital with a chief complaint of pressure feeling in the epigastrium. Aside from a gastric polyp already detected two years before at a mass screening of the stomach, x-ray examination of the upper gastrointestinal tract revealed a small tumor in the duodenal bulb. As the patient was very eager to have it removed, we excised it by surgical operation. The tumor, measuring 1.0 by 0.8 cm and elastic hard to the touch, was of spherical shape, slightly flattened. The cut surface was yellowish white. The tumor was confirmed as a carcinoid of the duodenum. Neither infiltration nor metastasis was found in the adjoining areas. Postoperative measurement of the urine for 5-HIAA was normal.

　So far we have been able to collect 15 reported cases of duodenal carcinoid in Japan including the present case. The age varied from 24 to 73 years, but the tumor was most often found in persons over the age of 60. The ratio of male to female was 11: 2. The site of origin was predominantly in the duodenal bulb: 11 cases against 2 in the descending limb. Except for a case in which the tumor extended from the bulb over to descending portion, not a single case was seen in other segments. Carcinoid with malignant degeneration accounted for 2 cases, or 13.3 percent. Of all carcinoid tumors in the digestive tract, their malignant degeneration was least often encountered in the duodenum excepting the appendix. One tumor was the size of a goose's egg, and the other, under 1 cm in diameter. Three cases, all more than 4 cm in width, were found to have infiltrated into the adjoining areas. The others 6 cases had neither infiltration nor metastasis, with their size all less than 2 cm in diameter. Not a case demonstrated high value of 5-HIAA in the urine, while argentophile reaction of tumor cells was observed in 6 out of 10 cases. Characteristic symptoms and signs of carcinoid syndrome were seen in a malignant case which was accompanied with abdominal pain and diarrhoea. Flushing of the face was seen in a benign case. The tumors in these cases were both more than 7 cm in diameter.

　Of great interest is the fact that as many as 6 cases were accidentally found in the excised duodenal bulb of the patients who had undergone gastrectomy on account of either duodenal ulcer or early gastric cancer. The tumors in these cases were all less than 2 cm in diameter.