原発性十二指腸癌とⅡc型早期胃癌および胃ポリポージスの重複例

A Primary Carcinoma of the Duodenum Associated with Early Gastric Cancer and Gastric Polyposis, a Case Report

　原発性十二指腸癌は比較的稀で，腸癌の約3％を占めるにすぎないといわれているが，小腸の中では，十二指腸は癌の好発部位で，小腸癌の約1/3から半数近くを占めている．しかし，十二指腸癌と胃癌が合併することはきわめて稀で，本邦ではまだ5例の報告をみるにすぎない．われわれは最近，原発性十二指腸乳頭上部癌とⅡc型早期胃癌，ならびに胃ポリポージスが併存した症例を経験したので報告する．

　Primary carcinoma of the duodenum is a relatively rare disease. The case presented here is a primary suprapapillary carcinoma of the duodenum accompanied with Ⅱc type early gastric cancer and polyposis of the stomach.

　The patient was a 68-year-old woman whose chief complaint was anemia. X-ray and endoscopic examinations revealed polypoid lesions on the body of the stomach, a small depressed lesion at the gastric angle and an ulcerative tumor resembling Borrmann Ⅱ type carcinoma in the 2nd portion of the duodenum. Biopsical study of these lesions led us to diagnose them as benign gastric polyps, gastric and duodenal cancers, respectively. Partial gastrectomy and pancreaticoduodenectomy were then porformed.

　Pathologic studies showed a 7 by 9 cm tumor with ulceration proximal to the papilla of Vater extending into the 2nd portion of the duodenum, a 1.0 by 0.7 cm depressed lesion in the angular portion of the stomach and four polypoid lesions in the body.

　Microscopically they were each tubular adenocarcinoma of the duodenum with no invasion to the pancreas and common bile duct, tubular adenocarcinoma confined to the gastric mucosa and regenerative hyperplastic polyps of the stomach. There were metastases to regional lymph nodes of the duodenum.

　This type of multiple lesions is very rare and only five cases of such a combination of duodenal cancer and gastric carcinoma have been reported in Japan so far.