乳頭部癌の1治験例

Carcinoma of the Papilla of Vater Diagnosed by Duodenofiberscopy: A Case Report

　患　者：66歳　男．

　病　歴：2カ月前に発熱，以後食思不振あり体重10kg減．1週間前黄疸出現．腹痛・嘔吐・出血を見ず，理学的にも高度黄疸のほか著変を認めない．

　A 66-year-old man who had experienced a febrile episode two months before entry followed by anorexia and weight loss of 10 kg was admitted with jaundice of one week duration. Abdominal pain, vomiting, hematemesis or melena was absent. Physical examination was unremarkable exccpt for deep jaundice.

　Examination of the blood showed a red blood cell count of 3,080,000 and hemoglobin of 10.6 g/dl. The feces was positive for occult blood. Liver function tests showed a total bilirubin of 11.1 mg/dl, an alkaline phosphatase of 12.7 Bodansky units, SGOT of 145 units, LAP of 135 units and a negative CCF test. The CRP was negative.

　An upper gastrointestinal series showed normal esophagus and stomach. Hypotonic duodenogram (Fig. 1) was interpreted as negative except for pressure deformity of the postbulbar region caused by a distended gallbladder. Celiac angiography excluded neoplasms of the liver, gallbladder and pancreas.

　Fiberoptic duodenoscopy disclosed a deformed papilla of Vater with ulcerations and bleeding (Fig. 2). Smooth-surfaced protrusion was noted on the longitudinal fold oral to the papilla (Fig. 3). Biopsy specimens showed adenocarcinoma (Fig. 4) and postbiopsy suction yielded malignant cells (Fig. 5).

　Pancreatoduodenectomy was performed. Histologically the tumor of the papilla (Fig. 6) was papillary adenocarcinoma (Fig. 7). Lymph-node metastases were absent.