{"created":"2023-06-19T10:29:44.311642+00:00","id":1835,"links":{},"metadata":{"_buckets":{"deposit":"e254dc51-3007-4fab-998e-e0a6e93ea3e8"},"_deposit":{"created_by":31,"id":"1835","owners":[31],"pid":{"revision_id":0,"type":"depid","value":"1835"},"status":"published"},"_oai":{"id":"oai:kwmed.repo.nii.ac.jp:00001835","sets":["1709617079800:35:325:597"]},"author_link":["110667","110668","110669","110670","110671","110672","110673","110674","110675","110676","110677","110678","110679","110680","110681","110682","110683","110684","110685","110686","110687","110688","110689","110690","110691","110692","110693","110694","110695","110696","110697","110698","110699","110700"],"item_10001_biblio_info_7":{"attribute_name":"書誌情報","attribute_value_mlt":[{"bibliographicIssueDates":{"bibliographicIssueDate":"2016","bibliographicIssueDateType":"Issued"},"bibliographicIssueNumber":"2","bibliographicPageEnd":"68","bibliographicPageStart":"57","bibliographicVolumeNumber":"42","bibliographic_titles":[{"bibliographic_title":"川崎医学会誌","bibliographic_titleLang":"ja"},{"bibliographic_title":"Kawasaki medical journal","bibliographic_titleLang":"en"}]}]},"item_10001_description_33":{"attribute_name":"記事種別(日)","attribute_value_mlt":[{"subitem_description":"症例報告","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_10001_description_34":{"attribute_name":"記事種別(英)","attribute_value_mlt":[{"subitem_description":"Case 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of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Endoscopy and Ultrasound, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Digestive Surgery, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Digestive Surgery, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Pathology 1, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Endoscopy and Ultrasound, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Endoscopy and Ultrasound, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Health Care Medicine, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of Clinical Nutrition, Kawasaki University of Medical Welfare"},{"subitem_text_language":"en","subitem_text_value":"Department of Intestinal Medicine, Satou Memorial Hospital"},{"subitem_text_language":"en","subitem_text_value":"Department of Gastroenterology, Kawasaki Medical School"},{"subitem_text_language":"en","subitem_text_value":"Department of General Internal Medicine 2 Gastroenterology and Hepatology, Kawasaki Medical School"}]},"item_10001_textarea_5":{"attribute_name":"抄録(英)","attribute_value_mlt":[{"subitem_textarea_language":"en","subitem_textarea_value":"Brunner’s gland hyperplasia is a duodenal neoplastic lesion, and its lesions measuring >40 mm in diameter are rare, accounting for <10% of cases. A search of the Ichushi (Japana Centra Revuo Medicina) database using the keywords “abdominal ultrasound” and “Brunner’s gland hyperplasia” yielded no relevant articles. Here we report a case of Brunner’s gland hyperplasia in which transabdominal ultrasonography (US) was useful for diagnosis. A female in her 50s presented to a local hospital complaining of anorexia, epigastric pain and tarry stool. She had anemia and esophagogastroduodenoscopy (EGD), which was performed to identify the source of bleeding, revealed a mass lesion measuring approximately 45 mm in diameter in the stomach. She was referred to our hospital for further examination. Blood biochemistry showed a hemoglobin (Hb) level of 9.1 g/dL, mean corpuscular volume (MCV) of 89.1 fL and mean corpuscular hemoglobin (MCH) of 30.0 pg, indicating normocytic normochromic anemia. The blood urea nitrogen (BUN)/creatinine (CRE) ratio was as high as 43.1. In our hospital, EGD revealed a 45×40 mm mass lesion almost obstructing the lumen in the duodenal bulb. Atypia of the mass surface was not prominent, but erosion with oozing bleeding was observed. A submucosal tumor was suspected, and biopsy was performed but did not lead to a definitive diagnosis. Plain contrast-enhanced computed tomography (CT) revealed a mass lesion with prolonged peripheral enhancement measuring approximately 45 mm in diameter in the duodenal bulb. There was a low-density area inside the mass, raising the suspicion of cystic degeneration and necrosis. There were no findings suggesting infiltration or metastasis to the surrounding organs, raising the suspicion of a submucosal tumor, but cancer could not be ruled out. US revealed a submucosal tumor measuring approximately 55 mm in diameter in the second to third layer of the posterior wall of the duodenal bulb. The muscularis propria was normal and mostly composed of multilocular cysts with solid components in the space between the cysts. Blood flow was relatively abundant, but there were no obvious irregularities in the diameter or shape of blood vessels. The above findings raised the suspicion of duodenal Brunner’s gland hyperplasia. It was decided to perform surgical resection, and she underwent open duodenal submucosal dissection. Histology of the surgical specimen revealed Brunner’s gland hyperplasia, cons istent with the ultrasonographic findings. Endoscopic ultrasonography is useful in the differential diagnosis of duodenal submucosal tumors, but also has disadvantages such that it is difficult to visualize the entire lesion, when the lesion is large. On the other hand, US can be applied to the detailed examination of the upper gastrointestinal tract, because there are no invasive endoscopic procedures and US can visualize relatively large lesions and, in particular, can be expected to satisfactory observe around the vestibule, like in the present case."}]},"item_10001_textarea_6":{"attribute_name":"抄録(日)","attribute_value_mlt":[{"subitem_textarea_language":"ja","subitem_textarea_value":"Brunner 腺過形成は十二指腸腫瘍性病変で，大きさが40mm を超えるものは10% 未満と稀である．医学中央雑誌で「腹部超音波」「Brunner 腺過形成」のキーワードで検索すると，関連した報告はない．体外式超音波検査（US）が診断に有用であったBrunner 腺過形成の一例を報告する．症例は50歳代，女性．食欲不振，心窩部痛とタール便を主訴に近医受診．貧血を認め，出血源検索目的に行った上部消化管内視鏡検査（EGD）で胃内に約 45 mm の腫瘤性病変を認め精査目的に当院紹介となった．血液生化学検査ではHb 9.1 g/dl，MCV 89.1 fl，MCH 30.0 pg と正球性正色素性貧血を認め，BUN/CRE 比は43.1と上昇していた．当院でのEGD では十二指腸球部に内腔をほぼ閉塞する45×40 mm の腫瘤性病変を認めた．腫瘤表面の異型性は目立たないが，oozing bleeding を伴ったびらん形成を認めた．粘膜下腫瘍を疑い生検も行われたが確定診断には至らなかった．単純造影CT では十二指腸球部に 45 mm 程度の腫瘤性病変を認め，辺縁は遷延性に造影された．内部は低吸収域が認められ，嚢胞変性や壊死が疑われた．周囲臓器への浸潤や転移を示唆する所見は認めず，粘膜下腫瘍が疑われたが癌は否定できなかった．US では十二指腸球部後壁の第２層から第３層に存在する約55 mm の粘膜下腫瘍が認められた．固有筋層は正常で，内部は大半が多房性嚢胞からなり，嚢胞間に充実成分がみられた．血流は比較的豊富であるが血管径や形状に明らかな不整は認めなかった．以上より十二指腸Brunner 腺過形成が疑われた．外科的切除の方針となり，開腹で十二指腸粘膜下層剥離術を行った．術材の組織診断はBrunner 腺過形成で超音波診断と矛盾しない所見であった．十二指腸粘膜下腫瘍の鑑別には超音波内視鏡が有用であるが，大きな病変では全体の描出が困難などの欠点もある．一方でUS は内視鏡侵襲なく，比較的大きな病変も描出可能で，特に本症例の様に前庭部付近は良好な観察が期待できるため，上部消化管の精査に応用できる．"}]},"item_10001_version_type_20":{"attribute_name":"著者版フラグ","attribute_value_mlt":[{"subitem_version_resource":"http://purl.org/coar/version/c_970fb48d4fbd8a85","subitem_version_type":"VoR"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"中藤, 流以","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"眞部, 紀明","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"平井, 伸典","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"岡本, 由佑子","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"村尾, 高久","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"松本, 英男","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"秋山, 隆","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"河合, 良介","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"畠, 二郎","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"石井, 学","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"藤田, 穣","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"松本, 啓志","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"鎌田, 智有","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"平井, 敏弘","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"佐藤, 通洋","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"塩谷, 昭子","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"春間, 賢","creatorNameLang":"ja"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"NAKATO, Rui","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"MANABE, Noriaki","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HIRAI, Shinsuke","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"OKAMOTO, Yuko","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"MURAO, Takahisa","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"MATSUMOTO, Hideo","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"AKIYAMA, Takashi","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"KAWAI, Ryousuke","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HATA, Jiro","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"ISHII, Manabu","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"FUJITA, Minoru","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"MATSUMOTO, Hiroshi","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"KAMADA, Tomoari","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HIRAI, Toshihiro","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"SATOH, Michihiro","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"SHIOTANI, Akiko","creatorNameLang":"en"}],"nameIdentifiers":[{}]},{"creatorNames":[{"creatorName":"HARUMA, Ken","creatorNameLang":"en"}],"nameIdentifiers":[{}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_date","date":[{"dateType":"Available","dateValue":"2017-03-09"}],"displaytype":"detail","filename":"KMJ-J42(2)57.pdf","filesize":[{"value":"1.5 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tumor","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Brunner’s gland hyperplasia","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Giant Brunner’s gland hyperplasia","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Duodenal tumor","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Transabdominal ultrasonography","subitem_subject_language":"en","subitem_subject_scheme":"Other"},{"subitem_subject":"Abdominal ultrasound","subitem_subject_language":"en","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"journal article","resourceuri":"http://purl.org/coar/resource_type/c_6501"}]},"item_title":"体外式腹部超音波が診断に有用であった十二指腸巨大Brunner 腺過形成の一例","item_titles":{"attribute_name":"タイトル","attribute_value_mlt":[{"subitem_title":"体外式腹部超音波が診断に有用であった十二指腸巨大Brunner 腺過形成の一例","subitem_title_language":"ja"},{"subitem_title":"A case report: a giant Brunner’s gland hyperplasia of the duodenum that\\ncould be diagnosed by transabdominal ultrasonography.","subitem_title_language":"en"}]},"item_type_id":"10001","owner":"31","path":["597"],"pubdate":{"attribute_name":"PubDate","attribute_value":"2017-03-09"},"publish_date":"2017-03-09","publish_status":"0","recid":"1835","relation_version_is_last":true,"title":["体外式腹部超音波が診断に有用であった十二指腸巨大Brunner 腺過形成の一例"],"weko_creator_id":"31","weko_shared_id":-1},"updated":"2024-04-16T02:02:46.299572+00:00"}