臨牀消化器内科 Vol.33 No.10(2-1)


特集名 十二指腸上皮性非乳頭部腫瘍の診療を巡って ― 現状と課題
題名 十二指腸上皮性非乳頭部腫瘍の臨床病理と分子生物学を巡って (1) 臨床病理概論
発刊年月 2018年 09月
著者 津山 翔 順天堂大学大学院医学研究科人体病理病態学
著者 八尾 隆史 順天堂大学大学院医学研究科人体病理病態学
【 要旨 】 十二指腸非乳頭部腫瘍はまれな腫瘍であるが,近年,その切除検体数は増加傾向である.十二指腸非乳頭部腫瘍は第1~2部の発生がその大半を占め,肉眼型は隆起型が多い.筆者らは十二指腸非乳頭部における低異型度高分化型上皮性腫瘍の細胞形質発現に基づく診断アルゴリズムを提唱した.鑑別困難な症例があるものの,同腫瘍の病理診断は基本的に胃型形質の有無を中心に判定すればよい.症例数が少なく,また,取り扱いが統一されていないため,その臨床病理学的特徴が明らかになったとは言い難い.症例の集約化およびさらなる解析が必要と考える.
Theme Diagnosis and Treatment of Non-ampullary Duodenal Epithelial Tumor -- Current Status and Issues
Title Clinicopathological Features and Diagnostic Criteria for Non-ampullary Duodenal Epithelial Tumors
Author Sho Tsuyama Department of Human Pathology, Juntendo University Graduate School of Medicine
Author Takashi Yao Department of Human Pathology, Juntendo University Graduate School of Medicine
[ Summary ] Non-ampullary duodenal epithelial tumors (NADETs) are rare, but the number of resected specimens has been increasing in recent years, both in Japan and in other countries. Most cases of duodenal non-papillary tumors occur in the 1st-2nd portion, and the main macroscopic type is protuberant. Histologically, Brunner's glands arising from the duodenal bulb to the proximal descending duodenum are considered a gastric phenotype. Tumors arising from the duodenum present as intestinal type, gastric type, and gastrointestinal mixed type on immunohistochemical analysis. Herein, we propose a new pathological diagnostic algorithm based on related reports. The diagnostic criteria for low grade duodenal epithelial tumors are basically the same as those of gastric cancer, although the differential diagnosis can be difficult. As the clinicopathological features have not been elucidated due to the extremely low incidence, it is important to collect more cases for analysis.
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