十二指腸の腫瘍―1．悪性腫瘍 胃癌との重複

PRIMARY CANCER OF THE DUODENUM: Case Report Double Cancer in the Duodenum and the Stomach

Ⅰ．はじめに

　原発性十二指腸癌は比較的稀な疾患とされている．Mateer²⁰⁾によると，176,000体の剖検で全部の癌の0.25％，腸癌の3％を占めており，Hoffmann¹³⁾によると，350,286体の剖検で0.033％に発見されたと報告されている．またNothnagel²⁸⁾によると，41,438体の剖検で443例の腸癌が発見され，そのうち十二指腸癌は7例（腸癌の0.63％）を占めており，Oberndorfer²⁸⁾によると5,768体の剖検で十二指腸癌は13例（0.22％）と報告されている．

　本邦の全剖検例における十二指腸癌の頻度は石橋：0.098％，長与：0.2％，鈴木：0.071％などである¹⁰⁹⁾．

　欧米では，Hamburger（1746）がはじめて原発性十二指腸癌を報告して以来Resnik（1958）が集計するまでに580例，それ以後現在にいたるまで69例^1)～34)総計649例報告されており，本邦では近藤が集計するまでに187例，それ以後著者の調査した51例計238例^35)～152)が報告されている．現在でもなお続々症例報告がなされており，原発性十二指腸癌およびその手術成功例の報告は近時急速に増加している．

　しかし原発性十二指腸癌と他癌との重複癌はきわめて稀であり，とくに胃癌と十二指腸癌の重複癌は欧米，本邦それぞれ1例計2例が報告されているにすぎない．

　著者は最近，胃癌で胃切除を施行してから約3年6カ月後に肺炎で死亡した患者の剖検において十二指腸癌を発見し，両者が独立した原発性の重複癌と考えられたので報告する．

　Primary carcinoma of the duodenum is a relatively rare disease, and in western countries there have been up to now only 649 such cases reported since Hamburger found it for the first time in 1746. In this country, reported cases amount to 238 to date.

　Coexistence of primary carcinoma of the doudenum with cancer of other organs is very uncommon, and double cancer of the stomach and the duodenum is rarer still; only two such cases, one in this country and the other in Europe, have ever been reported up till now.

　The authors recently happened to find duodenal carcinoma in the autopsy of a patient, who had died of pneumonia about three and a half year after the resection of his stomach on account of gastric cancer. As cancers of the stomach and the doudenum found in this case are considered as both primary and independent of each other in their origin, it is described in this paper at full length.

　Case: 73 years old Japanese male

　Cancer of the stomach was found by x-ray examination in March, 1963, and accordingly subtotal resection of the stomach was performed by Billroth I method. The excised cancer was dish-shaped, 7.5×6.8 in diam., with sharp demarcation. Pathohistologically it was papillary adenocarcinoma. The patient had favorable progress toward recovery. X-ray examination performed one year after the resection of the stomach revealed no sign of recurrence in the gastric remnant nor any abnormality in the duodenum. Unfortunately, in May, 1966, he was seized with apoplexy. Soon he took a turn for the worse, and in September of the same year, he died of accompanying pneumonia.

　Findings at autopsy: No recurrence was found in the gastric remnant, nor was there any metastasis to contiguous organs as well as to remote ones. Surprisingly enough, a broad-based polypoid tumor was found in the duodenum, 7 cm distal from the papilla of Vater and 13 cm away from gastroduodenal anastomosis. Histologically it proved to be papillary adenocacinoma.

　As there is no cancerous infiltration either around this lesion or in the area between it and the gastric remnant, with no metastasis to regional lymph nodes, this cancer is considered as of primary doudenal origin, independent of the initial gastric cancer, and so these two carcinomas each of different location assuredly constitute primary double cancer of the stomach and the duodenum.