臨牀消化器内科 Vol.23 No.10(7)


特集名 膵炎診療をめぐる最近の動向 -- ガイドライン,診断基準を含めて
題名 慢性膵炎と膵癌 -- 病理学的見解
発刊年月 2008年 09月
著者 須田 耕一 東京西徳洲会病院病理科/順天堂大学人体病理病態学
【 要旨 】 慢性膵炎と膵癌に関連性があるか否かについて検討/考察した.慢性アルコール性膵炎の切除膵組織について膵癌の前駆病変とされるPanINを調べると13例中7例にPanIN-1A / 1Bが認められ,別の1例にIPMNがみられた.先に検討したアルコール多飲者剖検膵では膵管上皮の過形成 (PanIN-1程度) が慢性アルコール性膵炎に相当する小葉間線維化で55例中26例にみられ,小葉内線維化では35例中2例であった.これらより慢性膵炎でPanINとより関連性があるともいえるが,low grade PanINでは膵癌との関連づけが困難である.このように膵石例を別にすると慢性膵炎と膵癌の関連性を肯定する病理学的な結果は得られなかった.
Theme A Trend in the Practice of Pancreatitis
Title Pathological Opinion / Standpoint in Relationship between Chronic Pancreatitis and Pancreatic Cancer
Author Koichi Suda Department of Pathology, Tokyo- West Tokushukai Hospital / Department of Human Pathology, Juntendo University School of Medicine
[ Summary ] The relationship between chronic pancreatitis and pancreatic cancer was studied, especially in pancreatic intraepithelial neoplasia (PanIN), which was a new nomenclature and classification system for pancreatic duct lesions and putative precursor lesions related to pancreatic cancer.
In cases with chronic alcoholic pancreatitis, PanIN-1A / 1B lesions were found in 7 out of 13 cases and intraductal papillary-mucinous neoplasm (IPMN) was also found in other one case. Our previous study in cases with chronic alcoholim showed that epithelial hyperplasia, which was considered to be PanIN-1A / 1B, was found in 26 out of 55 cases with interlobular fibrosis, and in 2 out of 35 cases with intralobular fibrosis. Hence, chronic pancreatitis cases were thought to be more closely related to PanINs, but low grade PanINs are difficult to relate to pancreatic carcinoma, because PanIN-1A / 1B seems to be found incidentally and frequently in elderly persons. Therefore, chronic pancreatitis, except cases of pancreatolithiasis, could not be elucidated relationship to pancreatic carcinoma.
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