臨牀消化器内科 Vol.24 No.9(4)


特集名 膵管内乳頭粘液性腫瘍(IPMN)
題名 IPMNとPanIN
発刊年月 2009年 08月
著者 高折 恭一 京都大学大学院医学研究科肝胆膵・移植外科
著者 吉澤 明彦 京都大学大学附属病院病理診断部
著者 川口 義弥 京都大学大学院医学研究科肝胆膵・移植外科
著者 土井 隆一郎 京都大学大学院医学研究科肝胆膵・移植外科
著者 真鍋 俊明 京都大学附属病院病理診断部
著者 上本 伸二 京都大学大学院医学研究科肝胆膵・移植外科
【 要旨 】 膵癌の予後はきわめて不良であるが,IPMNは一般に予後良好である.膵管内の顕微鏡的病変であるPanINは,通常型膵癌の前駆病変として提唱された概念で,膵癌に伴う遺伝子異常が段階的に蓄積している.一方,IPMNでも同様に遺伝子異常の蓄積を認め,非浸潤性のIPMNから浸潤癌に進展する症例もある.また,IPMNと通常型膵癌が同一膵に発生する場合もあるので,IPMNと高グレードのPanINが併存する症例には注意を要する.しかし,IPMNとPanINはどちらも乳頭構造を示すことが多い膵管内病変で,両者の鑑別は必ずしも容易ではない.そこで,本稿ではIPMNとPanINの臨床病理学的特徴と遺伝子異常について概説し,鑑別のポイントについて述べる.
Theme Intraductal Papillary Mucinous Neoplasm (IPMN)
Title Intraductal Papillary Mucinous Neoplasms and Pancreatic Intraepithelial Neoplasia
Author Tkyoichi Takaori Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine
Author Akihiko Yoshizawa Department of Diagnostic Pathology, Kyoto University Hospital
Author Yoshiya Kawaguchi Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine
Author Ryuichiro Doi Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine
Author Toshiaki Manabe Department of Diagnostic Pathology, Kyoto University Hospital
Author Shinji Uemoto Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kyoto University Graduate School of Medicine
[ Summary ] Pancreatic cancer is a devastating disease with a bleak prognosis. In contrast, intraductal papillary mucinous neoplasms, or IPMNs, are known for their good prognoses. As is true with other cancers, genetic alterations give rise to pancreatic cancer. Pancreatic intraepithelial neoplasia, or PanIN, has been proposed as a precursor lesion for pancreatic cancer and step-wise accumulation of genetic alterations has been demonstrated in PanINlesions. Similar, albeit not identical, step-wise accumulation of genetic alterations has been reported in IPMNs as well. Besides, it has been acknowledged that some IPMNs progress toward invasive tubular carcinomas, which is the most common histological phenotype of pancreatic cancer. Therefore, both PanIN and IPMNs are now considered precursors to pancreatic cancer. When both IPMNs and high-grade PanIN are manifested concomitantly in a single pancreas, it must be noted that the high-grade PanIN may first progress toward pancreatic cancer. Since IPMNs and PanIN share several common features, such as papillary growth in the pancreatic ducts, it is not always easy to differentially diagnose IPMNs and PanIN. In this paper, guidelines for differential diagnosis of PanIN and IPMNs are presented. The clinicopathological features of IPMNs and PanIN are also described herein with special references to genetic alterations.
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