十二指腸囊腫の1例

A Case of Duodenal Cystoma

　十二指腸良性腫瘍は従来稀なものとされて来たが，小腸全体から見ると十二指腸は比較的良性腫瘍の好発部位であり殊に十二指腸球部には比較的多く見られる．わが国でも近年漸次発表例が増加の傾向にあるが，十二指腸内視鏡の普及は発見率の向上に拍車をかけるであろうといわれて来た．今回私共は十二指腸良性腫瘍の中でもきわめて稀なcystを経験したので，過去本邦における文献に見られた十二指腸cystic tumor例と共に若干の考察を試み報告する．

症例

　患　者：69歳，男．

　主　訴：食事直後の上腹部不快感．

　家族歴：特記すべきことはない，

　既往歴：6年前十二指腸潰瘍で3カ月入院加療を受けたほか，4年前より高血圧症，動脈硬化性心臓病で断続的に加療を受けていた．

　A Cystoma of the duodenum, a rare occurence among its benign tumors, was recently encountered and surgically treated. The patient, a man 69 years of age, was seen first on October 1971 because of unpleasant sensation in the epigastrium directly after meal. As an abnormal shadow was recognized by x-ray, he was admitted to the hospital for thorough examination. He was slightly under-nourished. The heart was enlarged a little to the left. ECG showed LBBB with extrasystole.

　Compression study of the stomach by x-ray in erect position disclosed a round shadow defect the size of a finger tip in the duodenal bulb slightly in the anal side. Double contrast study also revealed a hemispheric tumor on the posterior wall of the bulb. It was of smooth surface with its margins looking soft. Its base was not so well defined. A diverticulum also the size of a finger tip was seen directly under the duodenal papilla on the side of the pancreatic head. The growth was seen by fiberduodenoscope as a hemispheric tumor on the posterior wall in the greater curvature side. It was yellowish gray white with smooth surface and was free from reddening, erosion or ulcer. Palpation by means of biopsy forceps suggested that it had elastic soft consistency. Biopsy specimens taken from the tip of the tumor showed histologically normal duodenal epithelium. Operation was done under a diagnosis of benign submucosal tumor of the duodenum.

　The resected specimen revealed a low plateau-like elevation, measuring 8×8×4 mm, covered by mucosa that went smoothly over to the adjoining areas. Histologically, a cyst was formed in the submucosa with a layer of columnar epithelium over it. In its neighborhood were seen ducts consisting of the same epithleium. Cellular reaction was strong around it associated with hyperplasia of lymphoid tissue. The tumor was interpreted as cystic dilatation of heterotopic gland.

　Some reference has also been made both to the reports in Japan of cystic tumor of the duodenum and to its literature in general.