早期胃癌に合併した早期十二指腸乳頭部癌の1例 [in Japanese] A CASE OF EARLY CANCER OF THE DUODENAL PAPILLA ASSOCIATED WITH AN EARLY GASTRIC CANCER [in Japanese]
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胃癌と十二指腸乳頭部癌の重複例の報告は少なく,両者が早期の例は本邦では7例の報告しかない.今回,この稀な早期合併例を経験したので,若干の文献的考察を加え報告する.症例は68歳の男性で,胃癌の診断を受け当科に紹介された.肝転移が疑われたため施行した内視鏡的逆行性胆管造影検査時に偶然乳頭部のびらんを発見した.生検結果は強い異形成を伴ったびらん性乳頭炎, Group IVであった.胃癌に対しては幽門側胃切除, D<sub>2</sub>郭清し,びらん性乳頭炎に対しては粘膜内癌が否定できなかったため,十二指腸下行脚を切開し乳頭部切除した.胃病変はtub<sub>1</sub>, t<sub>1</sub>, ly<sub>0</sub>, v<sub>0</sub>, n<sub>0</sub>, ow(-), aw(-), Stage Iaであった.乳頭部病変はtub<sub>1</sub>であったが, patAc, m, w<sub>0</sub>, ly<sub>0</sub>, v<sub>0</sub>, pn<sub>0</sub>, Stage Iであったので追加切除は施行しなかった.術後3年9カ月を経過し,再発の徴候なく外来通院中である.
Few cases of double cancer of the stomach and duodenal papilla have been reported in the Japanese literature so far, and there are only seven cases if we set limit to the both cancers to be in an early stage. In this paper, such a rare case of early cancer of the duodenal papilla associated with an early gastric cancer is reported with a review of these seven cases.<br> A 68-year-old man was admitted to the hospital for operation of a gastric cancer which was diagnosed by endoscopic biopsy at another hospital. Endoscopic retrograde cholangiography performed for suspected metastatic liver tumor unexpectedly revealed an erosion in the duodenal papilla. The biopsy specimens obtained showed erosive papillitis with marked dysplasia, Group IV.<br> Distal partial gastrectomy with lymphadenectomy was performed for the gastric cancer at the antrum, followed by a duodenotomy, and the ampulla was excised because carcinoma in situ could not be ruled out. Histological examination of the resected stomach indicated well-differentiated tubular adenocarcinoma confined to the mucosal layer without lymph node metastasis. The specimen of resected duodenal papilla demonstrated well-differentiated tubular adenocarcinoma in situ as suspected. However, additional resection was not performed because no invasion was found into vessels or at the edge. Convalescence was uneventful. The patient has been well for 3 years and 9 months postoperatively and is followed up on an ambulant basis.
- The journal of the Japanese Practical Surgeon Society
The journal of the Japanese Practical Surgeon Society 58(9), 2051-2055, 1997-09-25
Japan Surgical Association