腸囊胞と併存した原発性早期十二指腸癌の1症例

A Case of Early Primary Carcinoma of the Duodenum Associated with Enterogenous Cyst of Brunnerian Origin

　原発性十二指腸癌は比較的稀な疾患で，そのほとんどが剖検によるものであるが，最近消化管疾患に対するX線，内視鏡診断の進歩により臨床的にも発見されるようになった．しかしながら，それらは発見時に根治術可能といえども漿膜浸潤が高度な進行癌であり，その5年生存率は著しく低い．すなわち，Reiche1の報告では2％であり，McComb，Darling，Warren，らの報告でも20％～40％にすぎない．欧米においても十二指腸早期癌の報告はなく，今日なお早期発見には遠い疾患であると考えられる．われわれは1972年，三戸の報告に続いて，十二指腸上膝脚に腸囊胞と併存した原発性早期十二指腸癌を経験したので報告する．

　A 45 years old female attended the O.P.D. at the Nissei Hospital for liver disease and diabetes since January 1970. In November 1972, she felt uncomfortable in the epigastrium.

　X-ray examination of the upper digestive tract revealed a well-defined filling defect with smooth surface about 1.0 cm in diameter on the posterior wall of the first portion of the duodenum. Endoscopy showed in the same site a polypoid lesion with constriction. Its surface as a whole was of normal color and smooth. Two of four specimens obtained by biopsy at the same time revealed malignant nature. The remaining two showed normal duodenal mucosa.

　At operation, we found two polypoid lesions in the first portion of the duodenum. On retrospective x-ray study, a rhombic vague shadow was observed in the anal side of the polypoid lesion. Endoscopic picture also revealed fold-like projection with normal color and smooth surface below the lesion.

　Pathologically, the former was an enterogenic cyst of Brunnerian origin, a monolocular cyst covered with the epithelium resembling that of the Brunner's gland. The latter was differentiated adenocarcinoma that was 1.0×1.0 cm in size and localized within the mucosa. It was diagnosed as an early primary cancer of the duodenum.

　In the world literature, this case is the second of early primary cancer of the duodenum, following the first case of Mito (1972), and it is the smaller lesion.

　The patient is now living and well without any sign of relapse.