Vater乳頭部にカルチノイドと癌が共存した1例

Coexisiting Carcinoid and Carcinoma in the Papilla of Vater, Report of a Case

　Vater乳頭部に発生する腫瘍はほとんどが癌腫であって，カルチノイドは非常にまれである．われわれは最近，Vater乳頭部の腫瘍の中に組織学的にカルチノイドと腺癌が共存した1例を経験したので報告する．

症　例

　患　者：43歳，男，食堂経営（790308）．

　主　訴：上腹部痛，黄疸．

　既往歴，家族歴：特記すべきことなし．

　現病歴：約半月ほど前より食後に腹部膨満感があったが放置していた．1979年1月24日夜半，急に上腹部の激痛を訴えて井上病院に入院した．

　The patient a 43-year-old man was admitted to our hospital complaining of severe epigastric pain, chilles and fever. Laboratory examination on admislion showed leucocytosis and obstructive jaundice. Hypotonic duodenography revealed a round thumbtip-sized radiolucent area in the descending portion. Endoscopically the round smooth surface tumor of the papilla of Vater with erosion and bleeding was found. Endoscopic biopsy showed the possibility of carcinoid of the papilla of Vater. Pancreatoduodenectomy was performed on March, 1979.

　There was no lymph nodes involvements and no other sign of spread. On resected specimens, the tumor was with a size of 3×4×1.5 cm, and histologically two lesions coexisted in the tumor, the one was carcinoid which mostly developed in the submucosa of the papilla of Vater and showed various arrangement of cell nests that consists of uniform cells with small almost round nuclei, and the other was well differentiated adenocarcinoma. The cells of carcinoid were either negative for argyrophil reaction or for argentaffin reaction. No carcinoid symptom was encountered.

　About six months later, he was underwent laparotomy because of metastatic carcinoid to the retroperitoneal space. Clinicopathological features of coexisting carcinoid and adenocarcinoma of the papilla of Vater, which is very rare, have been discussed with a review of the literature.