A case of early duodenal bulb carcinoma

　症例は77歳,男性.食後の上腹部膨満感を主訴として,当院内科を受診した.上部消化管内視鏡検査,上部消化管造影検査,腹部造影CT検査で十二指腸球部に3cm大の腫瘤性病変を認めた.生検診断はGroupIIIであったが,有症状であり内視鏡的切除が困難で悪性の可能性も否定できなかったため,外科的切除を施行した.開腹所見として,十二指腸球部に可動性のある腫瘤を触知したが,周囲のリンパ節の腫脹は認めなかった.手術は胃球部切除術を施行した.摘出標本では幽門輪直遠の十二指腸球部に茎が1.5cmで大きさ2.0×2.0×1.0cmの有茎性腫瘤を認めた.病理組織検査はtubular adenocarcinoma, well differentiated typeで深達度は粘膜内であった.今回,幽門輪直遠に発生した早期十二指腸球部癌の1例を経験した.比較的稀な疾患であるため報告した.

We reported a rare case of early duodenal bulb cancer which occurred in the pyloric ring vicinity. The patient was a 77-year-old man with upper abdominal distention after meals as the chief complaint. We performed an upper gastrointestinal endoscopy, an upper gastrointestinal series and an enhanced abdominal CT examination. These examinations revealed an approximately 3cm mass lesion in the duodenal bulb. Although endoscopic biopsy revealed Group 3, it was difficult to resect the mass lesion by endoscopic therapy. Furthermore, the mass lesion had malignant possibilities, we decided to perform surgery. Because we confirmed the mobile mass lesion in the duodenal bulb during operation, we performed a necessary distal gastrectomy. However, we were not able to confirm the swelling of neighboring lymph nodes. Macroscopically, the tumor was 1.5cm in stalk and was 2.0×2.0×1.0cm in size, at the duodenal bulb. Microscopic diagnosis was well differentiated tubular adenocarcinoma of the duodenum, limited with in mucosal layer.

早期十二指腸癌

十二指腸球部