十二指腸第Ⅲ部の平滑筋肉腫の1例

A Case of Leiomyosarcoma of the Duodenum

　十二指腸に原発する悪性腫瘍の中で，癌腫は小腸のうち十二指腸に比較的多くみられるが，肉腫はきわめて稀で，Rocklin¹⁾によれば癌と肉腫の比は10：1とされている．

　著者らは最近，十二指腸第Ⅲ部の「粘膜下腫瘍」と診断し，悪性を強く疑って手術し，術後「平滑筋肉腫」であった症例を経験したので，内外の文献的考察を加えて報告する．

　Leiomyosarcoma of the duodenum is not so common, and it was rarely diagnosed preoperatively. Recently we encountered one case, so report it in this paper.

　A 24-year-old female patient was admitted to our hospital with the chief complaint of teery stool appeared four times a year since the end of December, 1971.

　On admission, she was found to be slightly anemic. but had no other abnormal signs. No abnormality was seen in the routine upper and lower GI x-ray examinations. At last we have done newly developed small-intestinalfiberscopy (SIF), and then we have found diffuse bleeding at the third portions of the duodenum.

　Retrospective hypotonic-duodenography revealed a tumor shadow with central barium freck there. The second SIF found a protruded region rising straightly in the lumen, and having same color of normal intestinal membranes and like bridging-folds. The clinical diagnosis was made suspicion of submucosal (perphaps malignant) tumor. At laparotomy, the tumor was localized to the third of the duodonum with no metastatic finding of liver and other abdominal lymph nodes.

　The tumor size was 1.8×1.4 cm large and 2.0 cm height with deep depression. Histologically, the tumor was diagnosed as leiomyosarcoma.

　The case is the 52 nd case in Japan from 1939 to 1971, and 93 cases were reported in foreign countries from 1920 to 1971. But our case is the most smallest tumor in the world literature. The patient is now living and well 6 months after operation with no evidence of metastic signs.