Shimizu N, Tanaka S, Morikawa J, Yorioka S, Fukuda S, Yamashita S, Bamba M, Hattori T, Hosoda S
Division of Int. Med., Kohoku-Sogo Hospital.
Gan No Rinsho. 1989 Jan;35(1):100-6.
A 70-year-old woman was referred for an evaluation of evidence indicating occult bleeding found in the feces and epigastralgia. Radiologic and endoscopic examinations disclosed a duodenal polyp at the bulb. A pathological examination of a biopsied specimen revealed a well-differentiated adenocarcinoma. The patient underwent a gastrectomy and an extensive duodenectomy, and the surgical specimen examined indicated a pedunculated polyp (1.0*2.0) at the duodenal bulb which, histologically, consisted of two distinct parts: one, a tubular adenocarcinoma, and the other, non-tumorous tissue. Most of the lesion was the former, whereas the latter was found at the bottom and at the stalk of the polyp, and consisted of hyperplastic foveolar structures with gastric type cells and pyloric type glands. The histological findings of the mucosa, which was clearly duodenal around the root of the polyp, indicated that the carcinomatous portion was confined to the mucosal layer. These findings indicate that the adenocarcinoma in this case originated from a duodenal polyp composed of aberrant gastric mucosa. Also included in this study is a review of 57 cases of early duodenal cancer of the bulb, that have been reported in Japan.
一名70岁女性因粪便潜血及上腹部疼痛等症状前来接受检查。影像学及内镜检查发现十二指肠球部有一息肉。活检标本的病理检查显示为高分化腺癌。患者接受了胃切除术及广泛的十二指肠切除术，手术标本检查显示十二指肠球部有一有蒂息肉（1.0×2.0），组织学上由两个不同部分组成：一部分为管状腺癌，另一部分为非肿瘤组织。病变大部分为前者，后者见于息肉底部及蒂部，由具有胃型细胞的增生性小凹结构和幽门腺组成。息肉根部周围黏膜的组织学表现明确为十二指肠，提示癌组织局限于黏膜层。这些发现表明，该病例中的腺癌起源于由异常胃黏膜组成的十二指肠息肉。本研究还回顾了日本报道的57例十二指肠球部早期癌病例。
