Vater乳頭に発生したカルチノイドの1例

Carcinoid Tumor in the Papilla, Report of a Case

　1907年Oberndorferは小腸腫瘍のうちで通常の癌腫とは異なる性状を有する腫瘤を経験し，これをcarcinoidと名付けた．以後この腫瘍の起源に関して幾つかの学説が提唱されてきたが，近年では，これが原腸系内分泌腫瘍であるとの学説が提唱され，また，形態学的ならびに組織化学的研究がなされ，報告例も増加している．本腫瘍については主として消化管，気管支などに発生したものの報告が多いが，今回われわれは従来極めてまれとされている，十二指腸乳頭部のカルチノイドの切除症例を経験したので報告する．

　The patient, a 49 year-old man, had been suffering from chronic hepatitis since 1978.

　Ultrasonography revealed the dilatation of the common bile duct, and hypotonic duodenography disclosed a round enlarged radiolucent area in the descending portion of the duodenum. Vater's papilla carcinoma was highly suspected and thus the surface mucosa of the Vater's papilla was biopsy. Though histopathological examination revealed no tumor cells, clinically Vater's papilla carcinoma could not be denied and surgical resection was performed.

　Distant metastasis was not recognized at operation. Grossly small submucosal tumor was located in the Vater's papilla.

　Histologically, the tumor consisted of trabecular and glandular proliferation of tumor cells with hyperchromatic round or oval nuclei. Grimelius stainpositive fine granules were observed in the cytoplasms. Ultrastructural finding demonstrated numerous neurosecretory granules in the cytoplasms. The tumor was diagnosed as carcinoid tumor. The tumor was small and localized. Therefore it was considered to show relative benign nature compared with those of other reported cases.

　Distant metastasis or invasive growth was not observed. Postoperative course is uneventful and no local recurrence or metastasis has been noticed so far.