胃と腸48巻10号

2013年09月発行

今月の主題 小腸の悪性腫瘍

主題

小腸悪性腫瘍の病理学的特徴―小腸GISTの病理学的特徴

著者： 櫻井信司¹

所属機関： ¹社会保険群馬中央総合病院病理診断科

ページ範囲：P.1409 - P.1416

文献概要

要旨　消化管において最も発生頻度の高い間葉系腫瘍は消化管間質腫瘍（gastrointestinal stromal tumor ; GIST）で，これは小腸に限定しても同様であるが，炎症性線維性ポリープ，炎症性筋線維芽細胞腫，腹膜，腸間膜に発生する孤立性線維性腫瘍，平滑筋肉腫，デスモイド腫瘍などの浸潤と正確に鑑別することが重要である．胃に発生するGISTと同様，正確な病理診断は術後のフォロー，治療に必須であり，診断名だけでなく正確な悪性度の評価が必要である．現在，複数の悪性度分類が存在するが，どの分類を用いて診断しているのか臨床医と確認しておくことが重要である．また，小腸にはまれに症候性の多発性GISTが発生するが，腹膜播種，転移と誤診してはならない．小腸GISTの診断には適切な免疫染色，悪性度の評価だけでなく，患者の背景を考慮した亜型診断が求められる．

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