胃・十二指腸に連続性に浸潤した深達度mの早期癌の1例

Early Gastric Carcinoma with Continuous Extension to the Duodenal Bulb, Report of a Case

要旨　患者は63歳の女性で上腹部不快感を訴えて来院した．胃X線および内視鏡検査所見から，幽門前部に全周性の，軽い結節状隆起や不整な陥凹の混在した粗糙な粘膜の拡がりと十二指腸球部のⅡa集籏様の隆起性病変を認めた．生検結果から，十二指腸腺腫を伴った幽門部早期胃癌と術前に診断したが，切除標本の検索で，胃・十二指腸に連続性に発育した深達度mの高分化型腺癌と診断された．癌の浸潤範囲は6.8×3.8cmで，十二指腸側の浸潤距離はBrunner腺出現部から16mmであった．癌は十二指腸側では異型の程度が弱く，胃側では一部に低分化腺癌を混じていた．早期癌の胃・十二指腸にまたがる浸潤は極めてまれであり，文献的考察を加えて報告した．

　A rare case of early gastric carcinoma with continuous extension to the duodenum was reported. A 63-year-old woman visited our hospital because of epigastric discomfort. The upper gastrointestinal x-ray and endoscopic examination revealed a whitish rough mucosal lesion in the prepyloric area, and an aggregated type Ⅱa-like elevated lesion in the duodenal bulb which was deformed by duodenal ulcer scar. Biopsy specimens showed adenocarcinoma in the stomach and adenoma in the duodenal bulb. Gastrectomy with partial duodenectomy was performed. Macroscopically, resected specimen showed a whitish rough mucosal lesion with slightly elevated multiple nodules and ashallow linear ulcer in the gastric part, and an aggregated type Ⅱa-like elevated lesion in the duodenal part. Histopathologically, a single lesion, 6.8×3.8 cm in size, was located in both the stomach and the duodenum. The carcinoma cells were limited within the mucosa and extended to the duodenum, 16 mm distant from the oral end of Brunner's gland's area. The lesion consisted of a well differentiated adenocarcinoma partially mixed with a poorly differentiated adenocarcinoma in the gastric part and a well differentiated adenocarcinoma with low grade atypic in the duodenal part.