十二指腸に腺腫と副膵の合併した1例

A Case of Double Tumors of Duodenum: Adenoma and Accesory Pancreas

　十二指腸良性腫瘍は比較的まれな疾患である．本邦では161例の報告があり，上皮性腫瘍72例，非上皮性腫瘍89例で，そのうち腺腫は11例を数えるのみである．われわれは最近胃X線検査の際，十二指腸下行部に透亮像を認め，種々の検査後手術施行し，腺腫と副膵を合併した1例を経験したのでここに報告する．

　The patient, a sixty-two-year-old woman, was admitted complaining of abdominal discomfort which appedare during the treatment for pyelonephritis.

　Laboratory examination on admission showed slight anemia and numerous red and white cells in urine sediment.

　Upon palpation no tenderness or tumor was found.

　Filling image of hypotonic duodenograpy revaled a round thumb-tip-sized radiolucent area in the discending portion, whereas double contrast duodengraphy revealed two tumor-shadows. The bigger one had a granular surface and the smaller one at oral side was a submucosal tumor with bridging folds.

　Cholangiography showed no abnormality. It means the lesion does not correspond to duodenal papilla.

　During endoscopic examination, only a large polypoid lesion which looked soft in consistency and showed a rough granular surface could be observed.

　Histological study of taken biopsy revealed slight atypism. Based upon this diagnosis and suspecting the development of malignancy we performed pancreato-duodenectomy.

　Gross specimen showed two tumors. One of them was 3.8×2.0×3.0 cm in size located about 0.7 cm from papilla, and its histo-pathological diagnosis was adenoma. The other one was 0.7×0.5 cm in size, and its histo-pathological diagnosis was accesory pancreas.

　Duodenal adenoma, is very rare particulary in Japan. Up to now as far as the author was able to find out only 12 cases have been reported. Accesory pancreas is also very rare. We know of only 8 cases reported up to now.