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Stomach and Intestine(Tokyo) Volume 19, Issue 12 （December 1984）

胃と腸 19巻12号（1984年12月発行）

Japanese English

症例

十二指腸乳頭部癌が先に診断されたGardner症候群の1例 Gardner's Syndrome Initially Diagnosed as Periampullary Carcinoma, Report of a Case 吉見富洋 ¹ , 小泉澄彦 ¹ , 石丸正寛 ¹ , 州之内広紀 ¹ , 藤枝邦昭 ¹ , 佐藤宗勝 ¹ , 武藤徹一郎 ² , 和田祥之 ² , 森岡恭彦 ² F. Yoshimi ¹ , S. Koizumi ¹ , T. Muto ² , Y. Wada ² , Y. Morioka ² ¹茨城県立中央病院外科 ²東京大学医学部第1外科 ¹Department of Surgery, Ibaraki Prefectural Central Hospital ²The First Department of Surgery, Faculty of Medicine, University of Tokyo pp.1373-1378

発行日 1984年12月25日 Published Date 1984/12/25

DOI https://doi.org/10.11477/mf.1403109532

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要旨　患者は46歳男子．1981年12月発熱と食欲不振を主訴に当科を受診した．灰白色便，可視的黄疸，全身掻痒感も認められたため1982年1月閉塞性黄疸の診断にて当科に入院した．入院後，上部消化管内視鏡検査にて，十二指腸乳頭部に一致して径約2cmの表面平滑な粘膜下腫瘤様の病変が認められ，生検組織診断により腺癌が認められたため，膵頭十二指腸切除術を施行した．標本にて癌は十二指腸乳頭部に一致し2.0×2.0×1.0cmの隆起性腫瘤であった．組織学的には乳頭腺癌．術後経過は順調にて外来通院中，約4カ月後に血便を主訴として来院．注腸造影，大腸内視鏡検査の結果，大腸全体にびまん性にポリープが認められた．家族歴も考慮し家族性大腸腺腫症の診断にて結腸全摘術を施行した．組織学的にはいずれも腺腫であり比較的大きいものは中等度異型性を示した．術後経過は順調であり，その後外来通院中に全身骨撮影にて右大腿および副鼻腔に骨腫が認められ，また幼児期に皮下腫瘤切除の既往も認められたため，Gardner症候群と診断された．

　This paper is to present a case of Gardner's syndrome initially diagnosed as periampullary carcinoma and found to be polyposis coli four months later.

　A 46 year-old man came to our hospital with complaints of general malaise and anorexia. Blood chemistry showed obstructive jaundice, and duodenoscopy revealed a hemispherical mass of the papilla of Vater. Biopsy histology showed adenocarcinoma and pancreatoduodenectomy was performed with uneventful course. Histologically carcinoma occupied the common channel, common bile duct and main pancreatic duct without any evidence of mucosal invasion of the duodenal mucosa with severe chronic pancreatitis. Carcinoma was assumed to arise from the common channel.

　Four months later, he came to our hospital with anal bleeding. Barium enema disclosed the presense of numerous polyps throughout the colon. He was diagnosed as adenomatosis coli and total colectomy wtih ileorectal anastomosis was performed. X-ray films showed osteomas of the facial bone and he was found to have Gardner's syndrome.

　Twenty-nine cases of periampullary carcinoma associated with Gardner's syndrome have been reported in world literature and the data was analyzed. There were only two examples of periampullary carcinoma diagnosed before the diagnosis of adenomatosis coli. It was also important to note that carcinoma associated with adenomatosis coli can arise in the common channel as well. The importance of barium enema examination was also stressed.