急速に発育した十二指腸球部胃型進行癌の1例

Advanced Duodenal Carcinoma Showing Rapid Growth, Report of a Case

要旨●患者は60歳代，男性．X年の人間ドックのスクリーニング上部消化管内視鏡検査（EGD）にて，十二指腸球部前壁に周囲粘膜とほぼ同様の色調の小隆起を認め，2年後も同様の所見であった．同病変は3年後には増大し，隆起表面の発赤，びらんを認めた．その1年後のX＋4年3月にはさらに増大，表面のびらんも深くなっていた．食道の多発ヨード不染帯の経過観察目的で精査機関にて行ったX＋4年8月のEGD時には，十二指腸球部病変は2型進行癌となっていた．外科的切除標本の病理組織学的検査では深達度pT3（SS）の進行癌で，免疫組織学的には，MUC5AC陽性で胃型形質の病変であり，その内視鏡像の経時的変化から急速に発育したと考えられた．

　A small, elevated lesion that was of the same color as the surrounding mucosa, was identified via EGD（esophagogastroduodenoscopy）during a medical checkup. The lesion appeared unchanged on EGD conducted 2-year later. However, EGD conducted 3-year later revealed a reddish and enlarged lesion with erosions on the surface. EGD performed after four years revealed further enlargement of the lesion with deeper erosions, however, the lesion was not diagnosed as adenocarcinoma, and histological examination of the biopsied specimen was not performed. An EGD performed at another hospital, after 4.4 years of the initial EGD revealed that the lesion had developed into a type 2 advanced carcinoma. Histological analysis of the surgically resected specimen indicated the presence of an invasive carcinoma that had reached the subserosa ; and immunohistochemical staining tested positive for MUC5AC, indicating a gastric phenotype. The lesion was considered to have rapidly enlarged from the time-course changes observed endoscopically.