臨牀消化器内科 Vol.21 No.2(1)


特集名 膵管内乳頭粘液性腫瘍 (IPMT ; intraductal papillary-mucinous tumor)
題名 概念の解説と分類
発刊年月 2006年 02月
著者 安川 覚 京都府立医科大学病理学教室
著者 小西 英一 京都府立医科大学病理学教室
著者 柳澤 昭夫 京都府立医科大学病理学教室
【 要旨 】 膵管内乳頭粘液性腫瘍 (IPMT) は予後の良い膵癌として特異な臨床的所見とともに本邦より報告されたことにはじまる.癌のほか,腺種や過形成なども報告されるようになり,2002年『膵癌取扱い規約』にて粘液の貯留による膵管拡張を特徴とする膵管上皮系腫瘍とされた.2000年のWHO分類ではIPMNと称され,日本とは名称は異なるが両者に分類される疾患はほぼ同様である.一方,小膵管の増殖性病変としてPanINが提唱されたが,これは用い方に問題があるが,あくまでも異型度分類であり,疾患名としてのIPMTとは区別して理解すべきである.IPMTは現在なおその自然史や臨床における悪性の基準などは不明瞭な点も多いが,国際ガイドラインも作成されつつあり,全世界からの集積によりこれらの疑問点が解明されるであろう.
Theme IPMT ; Intraductal Papillary-Mucinous Tumor
Title Explanation of Concept and Classification of Intraductal Papillary-Mucinous Tumors (IPMT)
Author Satoru Yasukawa Department of Pathology, Kyoto Prefectural University of Medicine
Author Eiichi Konishi Department of Pathology, Kyoto Prefectural University of Medicine
Author Akio Yanagisawa Department of Pathology, Kyoto Prefectural University of Medicine
[ Summary ] Intraductal papillary-mucinous tumors (IPMT) were initially reported in Japan in 1982 as being a form of pancreatic cancer with specific clinical features, having good prognoses. Then, adenoma and hyperplasia, as well as cancer, were also reported. In 2002, the General Rules for the Study of Pancreatic Cancer in Japan definitively noted that these lesions are pancreatic epithelial tumors, characterized by ductectasia due to mucous retention. In 2000, the WHO classification also listed IPMN (“neoplasm”). Although this is different from the Japanese name, the disease classified by these two terms is almost same. PanIN, which is a classification of atypism, should be distinguished from IPMT as a separate disorder. Currently, there are still numerous features of the natural history and malignant virulence of these conditions that remain unclear in clinical practice. Since the international guidelines have also been proposed, it is expected that these issues will be clarified by the compilation of information concerning cases from all parts of the world.
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