十二指腸乳頭部早期癌を伴う乳頭部腺腫の一例

Abstract

We report a rare case of early cancer in adenoma of the papilla Vater. An 81-year-old male was referred to our hospital for the purpose of close examination of jaundice. Abdominal echography and computed tomography revealed slight dilatation of the intrahepatic and common bile duct without any tumors or stones. Hypotonic duodeno- graphy and endoscopic examination showed the swelling of papilla Vater with irregularity and erosion of the surface. The biopsy specimen of the lesion was adenoma partially involved by spindle-shaped atypical epithelial cells with large chromation, suggesting the existence of adenocarcinoma. ERCP findings exhibited a defect shadow in the distal end of the common bile duct and slight dilatation of the main pancreatic duct. Endoscopic ultrasonography (EUS) showed a smooth swelling of papilla Vater, 25×13 mm in size, but no invasion into the surrounding tissues. Pancreatoduodenectomy was performed. His- tological diagnosis of the resected specimen was adenocarcinoma in adenoma of the papilla Vater, that stayed in the mucosal layer.