臨牀消化器内科 Vol.12 No.4(8)


特集名 十二指腸の腫瘍
題名 十二指腸のカルチノイド
発刊年月 1997年 04月
著者 長畑 洋司 神戸大学医学部第1外科
著者 斎藤 洋一 神戸大学医学部第1外科
【 要旨 】 カルチノイドは,原始腸管系臓器に散在性に存在する脳腸ホルモン分泌細胞を母細胞とする腫瘍群である.十二指腸カルチノイドは高頻度に他の悪性腫瘍やレックリングハウゼン病を併存し,発生部位は十二指腸球部が多く大きさは10mm以下で壁深達度は粘膜下層のことが多い.カルチノイド症候群の発生頻度は3%にすぎずセロトニン以外の種々の生理活性物質が関与し,また複数の活性物質が同時に証明されることもある.確定診断は病理組織学的に行われ,(1)組織型,(2)銀反応,(3)内分泌顆粒の電子顕微鏡的形態の三点が重要である. 治療方針は腫瘍径が16mm以上となれば一般の癌に準じた外科手術が必要になる.
Theme Duodenal Tumors
Title Carcinoid Tumor of the Duodenum
Author Yoshi Nagahata First Department of Surgery, Kobe University School of Medicine
Author Yoichi Saitoh First Department of Surgery, Kobe University School of Medicine
[ Summary ] Carcinoids are epithelial malignant tumors which invade into the submucosa or deeper layers of the digestive tract. Carcinoids should be referred to as gut-endocrinoma in order to include the few carcinoids which are histologically benign and have capsules in extragastrointestinal organs such as the lung and pancreas. Carcinoids of the duodenum are occasionally accompanied by synchronous malignant tumors or von Recklinghausen's disease. The majority of tumors are located in the first and second portions of the duodenum. Nearly half of the tumors are 10mm or less in size and often involve the submucosa of the duodenum. Manifestations of carcinoid syndrome are present in only 3% of patients with carcinoid of the duodenum. The definite diagnosis is made on the basis of histopathological findings, in which histologic types, silver impregnations and electronmicroscopic evaluation of endocrine granules in the neoplastic cells are considered important. Based on the general agreement concerning the above concepts, patients with carcinoids exceeding 16mm should usually undergo radical resection with D2 dissection of lymph nodes.
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