乳頭部にみられた早期十二指腸癌の1例

Early Carcinoma of the Duodenum, Report of a Case and Review of the Literature in Japan

要旨　患者は55歳，女性．下痢が主訴で，上部消化管X線検査で乳頭部癌を疑われ入院した．低緊張性十二指腸造影では乳頭部に直径4.3cmの陰影欠損があり，腫瘤は微細な顆粒と結節で構成される．内視鏡的には乳頭部は腫大し，一部のイクラ様の結節と，ほぼ平滑だが近接するとブツブツした小顆粒より成る腫瘤である．生検では高分化型管状腺癌であった．早期乳頭部癌と診断し膵頭・十二指腸・胃・胆囊切除術を行った．腫瘤は3.0×3.5×4.0cmで開口部はわずかに離れている．腫瘤と総胆管開口部は正常な十二指腸粘膜で隔てられていた．したがって，早期乳頭部癌に酷似した早期十二指腸癌であった．

　A 55-year-old woman was admitted to our hospital with a complaint of diarrhea and an abnormal x-ray findings in the 2nd portion of the duodenum. Hypotonic duodenography revealed a 43 mm defect with nodular and granular contour in the area of papillary Vater of the duodenum (Fig. 1 a, b). Endoscopically, the lesion was a large pedunculated polyp with fine granular surface (Fig. 2 a-d). Biopsy of the lesion showed a well differentiated tubular adenocarcinoma. Duodenogastro-pancreatectomy and cholecystectomy were performed. Macroscopically, the lesion was a 3.0×3.5×4.0 cm polyp in the area of papillary Vater (Fig. 3 a, b). Closeup view, however, revealed that the lesion was separated by normal mucosa of 0.5 cm width from an opening of the papillary Vater (Fig. 4 a-d). Thus, the final diagnosis was carcinoma outgrowing from the duodenal mucosa rather than from the papillary Vater.