乳頭部腫瘍（異型上皮）の1例

A Case Report of A Tumor in the Region of Papilla of Vater (Atypical Epithelium)

　患　者：神○義○　59歳　男

　主　訴：空腹時心窩部痛

　現病歴：約8カ月前に上腹部膨満感を訴え，某医にて治療を受け，自覚症状軽快した．1カ月前に胃透視を受け，十二指腸下行部に異常陰影を指摘され，当科は紹介された．

　入院時には空腹時心窩部痛が著明であった．22歳の時肺炎にて加療した以外，家族歴，既往歴ともに特記すべきことなし．

　A 59-year-old man had felt 8 months previously full sensation in the upper abdomen, and was treated by a doctor. His subjective symptom subsided for some time. One month before he was found to harbor an abnormal shadow in the second limb of the duodenum. He was then referred to our clinic. At admission he complained of strong hunger pain in the epigastrium. He had been treated for pneumonia when he was 22 years old, but otherwise there was nothing particular about both his family and his own past histories.

　Laboratory examinations at admission were noncontributory including those of the blood, urine, feces, blood sedimentation rate and function tests of the liver.

　Biopsy of the duodenum under direct vision revealed atypical glandular structure, although it was then impossible to classify it as cancer. Operation was performed.

　At operation, a granular tumor of irregular surface, 3.0×1.7×2.8 cm in dimensions, was seen in the upper part of the papillary region 12～13 cm distal from the pyloric ring. The tumor, of elastic soft consistency, was clearly distinguished from the surrounding mucosa. All observations including cytology during operation ruled out cancer, so that the tumor alone was excised.