| 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 (2) 形質発現と悪性度 | |
| 発刊年月 | 2018年 09月 | |
| 著者 | 鳥羽 崇仁 | 東邦大学医療センター大森病院消化器内科 |
| 著者 | 岡本 陽祐 | 東邦大学医療センター大森病院消化器内科／虎の門病院消化器内科 |
| 著者 | 菊池 大輔 | 虎の門病院消化器内科 |
| 著者 | 飯塚 敏郎 | 虎の門病院消化器内科 |
| 著者 | 布袋屋 修 | 虎の門病院消化器内科 |
| 著者 | 五十嵐 良典 | 東邦大学医療センター大森病院消化器内科 |
| 【 要旨 】 | 表在性非乳頭部十二指腸腫瘍（SNADET）はまれな疾患であるが，近年，内視鏡機器の進歩により発見される機会が増加している．しかし，その病態については未だ明らかにされていない．今回筆者らは粘液形質と悪性度の相関について明らかにするため，内視鏡切除したSNA-DET138病変を用いて検討した．組織学的異型度は低異型度腺腫と高異型度腺腫/癌の2群に分けて検討した．高異型度腺腫/癌では，低異型度腺腫と比較してMUC5AC（p＝0.002），MUC6（p<0.001）発現が有意に多く，CD10（p＝0.002），CDX2（p＝0.029）発現が有意に少なかった．また，多変量解析で高異型度腺腫/癌のリスク因子として，MUC6 expression（p＝0.001）発現が抽出された．SNADETにおける胃型形質発現は高異型度の指標になる可能性が示唆された． | |
| Theme | Diagnosis and Treatment of Non-ampullary Duodenal Epithelial Tumor -- Current Status and Issues | |
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| Title | Clinicopathological Features of Superficial Non-ampullary Duodenal Epithelial Tumors | |
| Author | Takahito Toba | Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center |
| Author | Yosuke Okamoto | Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center / Department of Gastroenterology, Toranomon Hospital |
| Author | Daisuke Kikuchi | Department of Gastroenterology, Toranomon Hospital |
| Author | Toshiro Iizuka | Department of Gastroenterology, Toranomon Hospital |
| Author | Shu Hoteya | Department of Gastroenterology, Toranomon Hospital |
| Author | Yoshinori Igarashi | Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Omori Medical Center |
| [ Summary ] | Superficial non-ampullary duodenal epithelial tumors (SNADETs) are relatively rare; however, lately these are being detected more commonly owing to advances in endoscopic technology. Nevertheless, the pathological nature of SNADETs remains unclear, and to date, an optimal management strategy has not been established for these tumors. We performed a retrospective analysis of 138 endoscopically resec ted SNADETs to gain a better understanding of the clinicopathological features. Lesions were classified into 2 groups: low-grade adenomas (LGA) (71 lesions, 51.4 %) and high-grade adenomas/carcinoma (HGA/Ca) (67 lesions, 48.6 %). Immunohistochemical analysis showed MUC5AC (p=0.002) and MUC6 (p<0.001) were significantly more commonly expressed and CD10 (p=0.002) and CDX2 (p=0.029) were significantly less commonly expressed in HGA/Ca lesions. Multivariate regression analysis showed that MUC6 expression (p=0.001) was an independent risk factor for the classification of HGA/Ca. The gastric phenotype of adenocarcinoma may be linked to the malignant potential of SNADETs. |
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