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要旨●患者は60歳代,男性.心窩部不快感で施行した上部消化管内視鏡検査で,十二指腸球部前壁を中心に,上面から下面にわたる半周性で約30mm大の隆起性病変を認めた.病変は大小不同の顆粒が集簇した形態で,その周囲にはNBI観察で胃底腺に類似した表面構造を有する2〜3mm大の小隆起が散在し,これらは異所性胃粘膜と考えられた.幽門側胃切除術,十二指腸球部切除術が施行され,切除標本病理では,病変は一部粘膜下層に浸潤する胃型形質を有した低異型度高分化型腺癌で,周囲および,腫瘍内には非腫瘍性の異所性胃底腺粘膜が残存しており,さらに癌の一部では胃底腺への分化を認めた.以上より,本症例は,異所性胃粘膜由来の早期十二指腸癌と考えられた.
A man in his 60s visited our clinic because of gastric discomfort. An esophagogastroduodenoscopy revealed a 30mm elevated lesion in the duodenal bulb. The lesion consisted of several large and small aggregated granules surrounded by 2-3mm elevated lesions, which were suspected to be composed of ectopic gastric mucosa. A distal gastrectomy with partial resection of the duodenal bulb was performed. Histological examination revealed that the tumor was gastric-type adenocarcinoma that had partially invaded the duodenal submucosa and showed characteristics of gastric fundic gland differentiation. Ectopic gastric mucosa with gastric fundic glands was observed in and around the tumor ; thus, this tumor was considered to be derived from congenital ectopic gastric mucosa.
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