十二指腸の腫瘍―2．良性腫瘍

BENIGN TUMORS OF THE DUODENUM

Ⅰ．緒言

　十二指腸良性腫瘍は十二指腸癌とともに比較的まれな疾患である．Cruveilhierが剖検で発見，発表したのが最初であるといわれているが，最近まで欧米では422例，本邦では87例が報告されている．十二指腸癌は欧米で649例，本邦で238例報告されており，良性腫瘍の報告は癌よりいくらか下まわるようである．

　その発見率についてはReiford¹⁰⁰⁾の56,500剖検例よりわずか13例，Hoffmann⁴⁹⁾の17年間の手術切除標本64,300例および24年間の剖検25,000例中8例発見されているのみであり，これらの発見率は0.02％ないし0.03％と低率である．

　Benign tumors of the duodenum are infrequently encountered. According to the authors' investigation, only 422 cases have been reported in Europe and in the United States, with 87 cases in this country. The duodenum is by far the shortest of all other portions of the small intestine, and yet it is the most common location for small bowel tumors. They are more often than not found in the part nearest the pyrolic ring. Histologically speaking, the ratio of epithelial, versus non-epithelial tumors is two to one, both abroad and at home. In Europe and in the United States, adenoma is most in number, or 40%, among epithelial tumors, and the next is adenoma of B1-unner's gland, or 16%. In this country the order of frequency is reverse. Among non-epithelial tumors, leiomyoma is found in an overwhelming majority. There are no specific signs and symptoms characteristic of duodenal benign tumors.

　Four cases of them have already reported by the authors elsewhere, and in this article are described three more cases of benign duodenal neoplasms.

　Case 1. A 81-year-old Japanese female

　The neoplasm is an adenoma of the Brunner's glands, situated 4cm anal from the pyloric ring and its size is 0.7×0.7 It was incidentally found at an operation of gastric cancer.

　Case 2. A 86-year-old Japanese male

　At autopsy, three tumors were found in the first and the second portions of the duodenum. The tumors are all caused by heterotopic proliferation of the intestinal epithelia and the Brunner's gland. Aberrant pancreas are intermingled in one of the tumors.

　Case 3. A 82-year-old Japanese female

　At autopsy, a tumor,1.0×0.8 cm in size, was found in the duodenum near the pyrolic ring. Histologically it is a tumor caused by proliferation of the Brunner's gland.