臨牀消化器内科 Vol.17 No.3(9)


特集名 膵嚢胞性疾患の取り扱い
題名 膵管内乳頭腫瘍と膵粘液性嚢胞腫瘍の臨床病理学的特徴と問題点
発刊年月 2002年 03月
著者 福嶋 敬宜 Department of Pathology, School of Medicine, Johns Hopkins University
【 要旨 】 膵管内乳頭(粘液性)腫瘍(IPMN)と膵粘液性嚢胞腫瘍(MCN)とは,形態的に類似している場合がありしばしば混同されてきた.ところがMCNの嚢胞壁に卵巣様間質(OS)が存在することが知られるようになり,改めて両者の違いに関心がもたれている.IPMNとMCNの病理学的鑑別には,膵管系との交通やそれに付随する所見の有無,OSの有無などが重要である.IPMN症例の蓄積に伴い,その浸潤癌への関心も高まっている.IPMNと通常の浸潤性膵管癌とは臨床病理学的に異なる疾患概念であるが,両者の発生・発育の違いに関しての分子生物学的説明は必ずしも十分にはなされておらず,形態的にも両者の中間に位置するような浸潤癌が存在する.
Theme Management of Cystic Diseases of the Pancreas
Title Clinicopathological Characteristics of Intraductal Papillary -- Mucinous Neoplasms and Mucinous Cystic Neoplasms of the Pancreas
Author Noriyoshi Fukushima Department of Pathology, School of Medicine, Johns Hopkins University
[ Summary ] Mucinous cystic neoplasms (MCNs) and intraductal papillary-mucinous neoplasms (IPMNs) are distinct clinicopathological entities. In this review, important features for differential diagnosis between IPMNs and MCNs are summarized. IPMNs are duct-ectatic neoplasms in the pancreatic head, with male predominance. MCNs are cyst-forming neoplasms in the body or tail of the pancreas, seen almost exclusively in females. MCNs are often accompanied by "ovarian-type stroma". These tumors take an indolent clinical course, when compared with conventional ductal carcinoma of the pancreas. Next, we review the recent immunohistochemical and molecular studies in IPMN. In contrast to the progress in understanding molecular genetics of invasive ductal adenocarcinoma, relatively little is known about what occurs in IPMN. However, some important studies such as LOH analyses, methylation analyses, etc. have also been performed in IPMNs. Finally, we focus on the invasive cases of IPMN, and then discuss the relationship between IPMN and invasive ductal adenocarcinoma of the pancreas, on the basis of clinicopathologic studies.
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