十二指腸球部早期癌の2例 PRIMARY EARLY CARCINOMA OF THE DUODENAL BULB : REPORT OF TWO CASES

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Abstract

われわれは十二指腸球部の早期癌を2例経験した.第1例は72歳の男性で,定期検診にて十二指腸球部内の異常陰影を認め,入院後の生検によりGroup IIIであったが,患者の希望で手術を施行した.切除標本の組織検査で,深達度mの早期癌と判明した.第2例は54歳の女性で,胃集検時に球部内の陰影欠損を指摘され,当院での内視鏡検査で球部内にカリフラワー状のポリープを認め,生検でpapillary adenomaと診断された.しかし,軽度のatypismも認められ悪性も否定できないために胃切除術を施行した.組織学的には深達度smの乳頭状腺癌であった.内視鏡的ポリペクトミーが普及しつつある現在,外科的処置にとって代わるような報告も散見されるが,今までに報告された早期十二指腸癌23例中,6例に脈管侵襲が見られ,その最小のもので1.8×1.3×0.9cmであった.少なくとも現時点では2cmを越えるものに対しては,積極的に外科的治療を行なうべきであると考えている.

In our hospital, 2 cases of primary duodenal cancer were experienced. One case was a 72-year-old man, who was pointed out to have a polyp of type IV of Yamada's classi-fication in the duodenal cap. The biopsy specimen was histologically diagnosed as adenoma. However, the patient wanted to have operation and gastrectomy was performed later. Histology of the resected specimen revealed tubular adenocarcinoma localized in the duodenal mucosal layer (m). The other case was a 54-year-old woman. She received upper GI series periodically, which showed an abnormal shadow in the duodenal bulb. Endoscopic examination and biopsy revealed a large polyp with slight atypism. The resected specimen revealed histologically early duodenal cancer (sm). Though endoscopic polypectomy is becoming popular, we had better perform opration for such a large polyp in the bulb over 2 cm in size.

Journal

  • GASTROENTEROLOGICAL ENDOSCOPY

    GASTROENTEROLOGICAL ENDOSCOPY 25(12), 1962-1967_1, 1983

    Japan Gastroenterological Endoscopy Society

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