原発性早期十二指腸球部癌の1例

Primary Early Carcinoma of the Duodenal Bulb, Report of a Case

　従来，原発性十二指腸癌と言えば進行癌の報告例であった．近年，上部消化管造影法，更には内視鏡検査法の発達により，十二指腸にも早期癌症例が散見されるようになった^1)～19)．

　最近われわれは術前に原発性十二指腸球部癌と診断し，病理組織学的検索の結果，深達度smの早期癌であった症例を経験したので報告する．

　In July 1980, a 63 year-old man was admitted to our hospital because of right hypochondralgia. Barium meal roentgenogram of the upper gastrointestinal series showed polypoid lesions of the duodenal bulb. Duodenofiberscopy revealed a hemispheric protrusion with nodular surface in the anterior wall of the duodenal bulb and multiple small polypoid lesions surrounded the main mass. Bleeding was seen at the surface of the lesion. Biopsy specimen showed adenocarcinoma.

　Gastrectomy, partial duodenectomy and lymph node dissection were performed. Gross appearance of the resected specimen showed a main nodular polypoid mass with a broad base, measuring 35×35 mm in diameter, in the anterior wall of the duodenal bulb, being adjacent to the pyloric ring, and whitish aggregated IIa-like polypoid lesions surrounded the main tumor. Histological examination of the resected specimen disclosed papillotubular adenocarcinoma located within mucosa and submucosa without lymph node metastasis.

　In addition, twenty cases of the primary early carcinoma of the duodenum excluding duodenal papilla in Japanese literature were also reviewed.