原発性早期十二指腸球部癌の1例

A Case of Early Primary Carcinoma of the Duodenal Bulb

　原発性十二指腸癌は比較的稀な疾患であるが，従来の上部消化管X線検査や低緊張性十二指腸造影に加え，最近の十二指腸内視鏡検査の進歩により，その報告例は漸次増加しつつある．しかし，十二指腸早期癌の報告はきわめて少なく，本邦では，三戸¹⁾の報告以後7例をみるにすぎない．

　われわれは，X線および内視鏡検査によって原発性十二指腸球部癌と診断し，病理組織学的検査の結果，早期癌であった症例を経験したので報告する．

　In July 1976, a 67-year-old woman sought medical advice because of recurrent epigastric pain since 1973. Physical examination revealed deep tenderness on palpation at epigastrium. No abdominal mass was noted. Stool was positive for occult blood. Roentgen examination of the upper gastrointestinal tract revealed a round, well-defined filling defect with irregular surface on the posterior wall of the duodenal bulb. Endoscopic examination showed a round nodular polypoid lesion with erosion and bleeding, suggesting the possibility of duodenal carcinoma. The endoscopic biopsy showed adenocarcinoma.

　Surgical operation found a round nodular polypoid lesion, measuring 1.2×1.0 cm, arising from the posterior wall of the duodenum distal to the pyloric ring by about 2 cm. The center of the tumor was slightly depressed. The tumor was resected by the Billroth I method. Histological diagnosis was well-differentiated adenocarcinoma grown in the mucosa.

　This case appears to be the first case report of early carcinoma of the duodenal bulb, although seven cases of early carcinoma of the duodenum have been described so far in Japan.