乳頭部近傍で深部浸潤した結節集簇様表層拡大型十二指腸癌の1例

Superficial Spreading Type Duodenal Cancer Arising from Nodule-aggregating Tumor, Report of a Case

要旨　患者は79歳，女性で，貧血および胆道系酵素の上昇の精査目的で当科に入院した．低緊張性十二指腸造影および内視鏡検査で十二指腸第2～3部に全周性で白色調の結節集簇様病変を認めた．病変は乳頭部近傍で陥凹し暗赤色調かつ無構造となり，乳頭開口部付近から自然出血を認めた．結節集簇様病変は粘膜内病変，乳頭部近傍は進行癌と診断し，膵頭十二指腸切除術を施行した．病変は最大長径12cm，全周性に表層拡大した結節集簇様病変で乳頭部を含む径約4cmの陥凹部に一致して深部浸潤を認めた．病理組織学的にはⅠ＋Ⅱa＋2type，tub1/pap/tub2 with tubulo-villous adenoma，se，ly₂・v₀，n₁，12×11.5cmの結節集簇様に表層拡大した十二指腸癌で膵頭部，下部胆管および膵管内に浸潤していた．表層拡大型十二指腸癌症例は極めてまれであり，臨床病理学的検討を加えて報告した．

　A 79-year-old woman was admitted to our hospital because of more detailed evaluation of anemia. Hypotonic duodenography and endoscopy showed a nodule-aggregating tumor with non-structual depressive lesion near the papilla of Vater, measuring 12cm in length, in the second and third portion of the duodenum. A pancreatico-duodenectomy was performed. A resected specimen showed a nodule-aggregating tumor and invasive cancer near the papilla of Vater invading the pancreas head, inferior bile duct and main pancreatic duct. Histological examination showed well differentiated and papillary adenocarcinoma with tubulo-villous adenoma in a nodule-aggregating tumor, and moderately differentiated adenocarcinoma in ulceration near the papilla of Vater. In summary, our case was diagnosed with superficial spreading type duodenal cancer arising from a nodule-aggregating tumor invading the pancreas head, inferior bile duct and pancreatic duct, I＋IIa ＋2type, tubl/pap/tub2 with tubulovillous adenoma, se, ly₂・v₀, n₁, 12 × 11.5 cm.