乳頭部癌の1例

Cancer of the Papilla of Vater, Report of a Case

　患　者：T. K.　45歳　男性

　既往歴：12年前胃潰瘍で胃切除（BI法）

　経　過：発症と同時に増強する黄疸のため昭和45年4月11日入院．Courvoisier's signを認め，下部胆道閉塞の診断で外胆のう瘻設置．X線，内視鏡検査で乳頭部癌と診断し，黄疸軽減を待って膵頭十二指腸切除を行なった．肝，リンパ腺転移なし，術後2年を経過した現在健在．

　The patient, a 45-year-old man, had a previous history of gastrectomy done 12 years before because of gastic ulcer.

　He was admitted to the hospital on April 11, 1970, on account of icterus which had become worse directly after its onset. As the Courvoisier's sign was recognized, external fistula of the gallbladder was made under a tentative diagnosis of occulsion in the distal choledochus. Subsequent examinations by x-ray and endoscopy demonstrated carcinoma in the papillary region. After waiting for jaundice to subside, we performed pancreatoduodenectomy. No metastasis was recognized either to the liver or to lymph nodes He is in good health two years after the operation.

　Hypotonic duodenography revealed a shadow defect, measuring 20×30 mm, at a site corresponding to the papillary region. In profile view it was seen as a two-peaked protrusion. A Nélaton's catheter was visualized on account of external fistula of the gallbladder.

　Endoscopy by FGS-BL showed a flat, sharply circumscribed protrusion at a site corresponding to the papillary region, which was displaced on account of previous gastrectomy. The surface of the protrusion was slightly reddened, appearing velvety.

　In the resected specimen a localized protrusion, measuring 2.2×2.0 cm, was seen directly oral to the papillary orifice. The cut surface of the tumor showed massive intraluminal growth of the tumor stretching the bile duct. Histologically, it was papillotubular adenocarcinoma, simulating intestinal epithelium. The pancreatic duct was dilated, but no atrophy of the pancreatic tissue was in evidence.