Maeda T, Iwasaki M, Hamaya M, Kameya S
Dept. of 2nd Surgery, St. Marianna Univ. school of Medicine, Kawasaki, Japan.
Nihon Geka Gakkai Zasshi. 1997 Nov;98(11):972-5.
A 73-year old woman consulted our hospital for consciousness disorder and was hospitalized under a diagnosis of cerebral infarction. On admission, retention of a large volume of ascites was noted. There were also marked increases in tumor markers. Serum CEA, CA19-9 and CA125 levels were 871.9 ng/ml, 1048.2U/ml, and 444.7U/ml, respectively. Cytological examination of the ascites showed class V. Abdominal CT showed a mass measuring 4 cm in diameter and dilatation of the small intestinal tract. During detailed examination, she developed ileus. Fluoroscopy through the lung tube suggested a small intestinal tumor. Laparotomy was performed to relieve ileus. In the abdominal cavity, the greater omentum formed a mass due to dissemination. Tumor was found in the jejunum approximately 60 cm from Treitz's ligament toward the anal side. Omentectomy and partial jejunectomy were performed. Macroscopic findings showed tumor protruding from the mucosal surface. Histological diagnosis was mucinous adenocarcinoma. Primary small intestinal cancer is very rare. In particular, only one case of mucinous adenocarcinoma of the small intestine was reported in Japan. We reported the second case in Japan with a review of the literature.
一名73岁女性因意识障碍前来我院就诊，被诊断为脑梗死并住院。入院时，发现有大量腹水潴留。肿瘤标志物也显著升高。血清癌胚抗原（CEA）、糖类抗原19-9（CA19-9）和糖类抗原125（CA125）水平分别为871.9 ng/ml、1048.2 U/ml和444.7 U/ml。腹水细胞学检查显示为V级。腹部CT显示一个直径4 cm的肿块以及小肠扩张。在详细检查过程中，她出现了肠梗阻。经肺管透视提示小肠肿瘤。为缓解肠梗阻进行了剖腹手术。在腹腔内，大网膜因播散形成了肿块。在距Treitz韧带向肛门侧约60 cm处的空肠发现了肿瘤。进行了大网膜切除术和部分空肠切除术。肉眼检查发现肿瘤从黏膜表面突出。组织学诊断为黏液腺癌。原发性小肠癌非常罕见。特别是在日本，仅报道过一例小肠黏液腺癌。我们报告了日本的第二例病例并对文献进行了回顾。
