胃と腸58巻8号

2023年08月発行

今月の主題 十二指腸拡大内視鏡の最新知見 主題

非乳頭部十二指腸腺腫・癌の拡大内視鏡診断—自施設での考え方

著者： 赤澤陽一¹ 上山浩也¹ 山本桃子¹ 岩野知世¹ 内田涼太¹ 宇都宮尚典¹ 阿部大樹¹ 沖翔太朗¹ 鈴木信之¹ 池田厚¹ 竹田努¹ 上田久美子¹ 北條麻理子¹ 津山翔² 八尾隆史³ 永原章仁¹

所属機関： ¹順天堂大学医学部消化器内科学講座 ²石川県立中央病院病理診断科 ³順天堂大学大学院医学研究科人体病理病態学

ページ範囲：P.1024 - P.1035

要旨●今回，当院での非乳頭部十二指腸上皮性腫瘍（NADET）における粘液形質に基づいた臨床病理学的・内視鏡的特徴について解析を行った．当院で内視鏡的ないし外科的切除を行い，免疫組織化学的に粘液形質の評価を行ったNADET 150病変において，胃腸混合型および分類不能型形質を除いた胃型NADET 19例と腸型NADET 73例に対して，臨床的・内視鏡的特徴について比較検討を行った．胃型NADETは球部に多く発生し（94.7%），発赤調（78.9%）で，0-I様病変が多く（68.4%），白色光観察にて分葉状・顆粒状構造を示し（63.2%），NBI併用拡大観察（M-NBI）では卵円形の腺窩辺縁上皮（66.7%），dense pattern（60.0%），窩間部の開大（80.0%）が特徴的であった．一方，腸型NADETでは，下行部に多く発生し（75.3%），同色〜白色調で（71.2%），0-IIaないし0-IIc様病変が多く（84.9%），M-NBIではWOS陽性（90.0%），LBC陽性（94.3%）が特徴的であった．NADETにおける胃型形質および腸型形質に特異的な内視鏡所見が明らかとなり，それぞれの内視鏡的鑑別は可能と考えられるが，一部に非典型例が存在するため注意が必要である．今後は用語の統一を含め，診断精度の高い内視鏡診断アルゴリズムの作成が期待される．

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