小Ⅱc様早期十二指腸癌の1例

Early Cancer of the Duodenum, Report of a Case and Review of Japanese Literature

要旨　57歳男性．胃潰瘍の治療目的にて入院中，胃十二指腸造影で十二指腸球部より第二部にかけて数個の隆起性病変が見出された．低緊張性十二指腸造影にて同部に数個の隆起性病変と，大乳頭の後壁寄りにバリウム斑が描出された．内視鏡検査では乳頭口側に隆起病変を，肛門側に不規則な陥凹性病変を認めた．内視鏡直視下生検にて，隆起性病変はBrunner腺の過形成，陥凹性病変は低分化粘液腺癌と診断された．以上より十二指腸第二部の癌と診断し胃部分切除および膵頭部十二指腸切除術を施行しChild法にて再建した．切除標本では大きさ1.3×1.0cm，肉眼的にはⅡcで病理組織学的には低分化粘液腺癌で深達度はsmであった．文献上，本例は本邦十二指腸第二部の早期癌としては第8例目，陥凹型の早期癌としては第3例目に当たると考えられた．

　A 57 year-old man was admitted to Fukuoka University Hospital because of the treatment for gastriculcer. A upper gastrointestinal x-ray series showed benign ulcer on the posterior wall of the gastric angle and multiple sessile polypoid lesions in the second portiorl of the duodenum.

　On a hypotonic duodenography, faint barium fleck was visible besides the papilla in addition to the sessile polypoid lesions. Upper gastrointestinal endoscopy revealed an irregular depressed area near the papilla and this lesion was proved to be adenocarcinoma by biopsy specimen. Multiple polypoid lesions were hyperplasia of the Brunner's gland.

　Partial gastrectomy and pancreatico-duodenectomy were erformed. Resected specimen showed a small irregular depressed rea, 1.3×1.0cm, just below the papilla.

　Histologically, this lesion was mucus-producing poorly differentiated adenocarcinoma and cancer cells were limited within the submucosal layer of the duodenum.

　Early duodenal cancer confined to the submucosal layer in the second portion, excluding the duodenal papilla cancer, was reviewed in Japanese literature.

　There were eight cases of early cancer so far, and they were six polypoid type and two depressed type.