再発・転移なく6年間経過観察しえたZollinger-Ellison症候群を伴う十二指腸カルチノイドの1例

Duodenum Carcinoid Accompanied by the Zollinger-Ellison Syndrome which could Carry Out Progress Observation for Six Years without a Recurrence and a Transition, Report of a Case

要旨　患者は57歳，男性．著明な下痢で発症し，内視鏡検査で十二指腸第2部に粘膜下腫瘍を認め，生検でカルチノイド腫瘍，免疫染色で抗ガストリン抗体陽性であった．血清ガストリン値は1,300pg/ml（基準値 ; ＜200pg/ml）と著明な上昇，セクレチン負荷試験，選択的動脈内刺激薬注入試験（selective arterial secretagogue injection test by calcium ; Calcium-SASI）から膵頭・十二指腸領域に発生したガストリノーマによるZollinger-Ellison症候群と診断した．術前検査では転移の所見はなく，2006年2月に十二指腸局所切除を行った．切除標本の病理所見では，腫瘍径8×5mm，粘膜下層にとどまるカルチノイド腫瘍で，脈管侵襲はなく，Ki-67 labeling index，核分裂像からWHO分類のNET（neuroendocrine tumor）G1に相当すると考えられた．切除後には自覚症状は改善し，血清ガストリン値も正常値となった．その後6年間，無再発生存中である．

　The patient was 57 years old and a male. Symptoms developed in intense diarrhea, a submucosal tumor was observed in duodenum part II by endoscopy, and it was the anti-gastrin antibody positivity in carcinoid tumor and immunity dyeing at the biopsy. The serum gastrin level was 1,300pg（s）/ml（standard level ;＜200pg/ml）, a remarkable rise, a secretin load examination, and the selective intraarterial stimulative infusion examination in an alternative artery（selective arterial secretagogue injection test by calcium : Calcium-SASI）, that was diagnosed as the Zollinger-Ellison syndrome by the gastrinoma which occurred in the head of pancreas, and the duodenum domain. In February 2006, before the operation, there was no view of transition and it was performed duodenum local excision. In the pathology views of the excision specimen, there was no pulse pipe invasion in the carcinoid tumor which was within the diameter of 8×5 mm, and it was thought to be equivalent to NET（Neuroendocrine tumor）G1 of a WHO classification in the view of Ki-67 labeling index, and the nuclear fission image. The subjective symptoms were improved after excision, and the serum gastrin level also turned into a normal level. The patient has been still alive for six years after that.