乳頭部癌の1例

Cancer of the Papillary Region of the Duodenum: Report of a Case

　患　者：S. S.　59歳，女

　主　訴：黄疸および発熱．

　現病歴：昭和46年3月より無痛性黄疸あり，発熱を伴う．内科的治療にて黄疸軽減せず．6月3日当院受診し11日入院する．

　現　症：体格小，栄養不良，全身に黄疸貧血を認め，肝2横指および腫大した胆囊を触知す．

　This is a report of cancer in the papillary region of the duodenum seen in a 59-year-old woman with chief complaints of jaundice and fever. Since March 1971 she noticed jaundice, which was painless but was accompanied with bouts of fever. Despite medical management icterus did not abate and she visited our hospital on June 3. Admission on 11.

　Physical examination showed a poorly nourished woman of rather low stature with noticiable icterus and anemia on the mucous membrane. The liver was palpable two-finger-breadth below the costal margin. The gallbladder was distended and palpable as well.

　Laboratory examinations revealed 2,390,000 red blood cells with 18,900 white blood cells. The total serum protein was 6.8 gr. per 100 ml. and total serum bilirubin 6.6 mg. per 100 ml. (direct bilirubin 4.7 mg. per 100 ml.). Total serum cholesterol was 228 mg. per 100 ml., alkaline phosphatase 36.6 units (BasseyLowry). SCOT and SGPT were 14.1 and 6.4 units, respectively. Urinanalysis showed 1 ＋ for urobilino-gen and 2 ＋ for bilirubin. The stool was positve for occult blood.

　Hypotonic duodenography and transhepatic percutaneous choledochgraphy, both done to find out the cause of obstructive jaundice, revealed swollen papillary region with irregular mucosal surface with irregularly interrupted distal end of the common bile duct. Duodenofiberscope also showed swollen papillary region with mucosal erosions, reddenedlor bleeding spots. As cancer tissue was demonstrated by biopsy, pancreatoduodenectomy was done on July 12 under a tentative diagnosis of cancer of the papillary region. Metastasis was noticed in 3 out of 14 lymph nodes. Histologically it was adenocarcinoma papillotubular.