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Stomach and Intestine(Tokyo) Volume 60, Issue 6 （June 2025）

胃と腸 60巻6号（2025年6月発行）

Japanese English

今月の主題非乳頭部十二指腸浸潤癌の臨床病理学的特徴

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非乳頭部十二指腸SM以深浸潤癌の臨床病理学的特徴—外科的切除例を含めて Clinicopathological Characteristics of Submucosal Invasive Carcinoma in Non-ampullary Duodenal Cancer 松枝克典 ¹ , 神崎洋光 ^1,2 , 竹中龍太 ² , 中川昌浩 ³ , 松枝和宏 ⁴ , 青山祐樹 ¹ , 濱田健太 ⁵ , 河野吉泰 ¹ , 山崎泰史 ¹ , 岩室雅也 ¹ , 川野誠司 ¹ , 河原祥朗 ⁵ , 田中健大 ⁶ , 大塚基之 ¹ Katsunori Matsueda ¹ , Hiromitsu Kanzaki ^1,2 , Ryuta Takenaka ² , Masahiro Nakagawa ³ , Kazuhiro Matsueda ⁴ , Yuki Aoyama ¹ , Kenta Hamada ⁵ , Yoshiyasu Kono ¹ , Yasushi Yamasaki ¹ , Masaya Iwamuro ¹ , Seiji Kawano ¹ , Yoshiro Kawahara ⁵ , Takehiro Tanaka ⁶ , Motoyuki Otsuka ¹ ¹岡山大学病院消化器内科 ²津山中央病院内科 ³広島市民病院内視鏡科 ⁴倉敷中央病院消化器内科 ⁵岡山大学研究院実践地域内視鏡 ⁶岡山大学病院病理診断科 ¹Department of Gastroenterology and Hepatology, Okayama University Hospital, Okayama, Japan ²Department of Internal Medicine, Tsuyama Chuo Hospital, Tsuyama, Japan ³Department of Endoscopy, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan ⁴Department of Gastroenterology and Hepatology, Kurashiki Central Hospital, Kurashiki, Japan ⁵Department of Practical Gastrointestinal Endoscopy, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan ⁶Department of Pathology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan キーワード：非乳頭部十二指腸癌 , SM癌 , Vater乳頭口側 , 胃型形質 Keyword: 非乳頭部十二指腸癌 , SM癌 , Vater乳頭口側 , 胃型形質 pp.817-829

発行日 2025年6月25日 Published Date 2025/6/25

DOI https://doi.org/10.11477/mf.053621800600060817

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要旨●非乳頭部十二指腸粘膜下層浸潤癌（SM癌）の臨床病理学的特徴を明らかにするために，多施設で収集した非乳頭部十二指腸癌165病変（M癌70病変，SM癌11病変，進行癌84病変）を対象として検討を行った．SM癌は，腫瘍径10mm以下の小さな病変が比較的多く，すべてVater乳頭口側に存在していたのに対し，M癌ではVater乳頭口側と肛門側にほぼ等しく分布していた．進行癌はSM癌と同様にVater乳頭口側に多く存在した．粘液形質は，SM癌は胃型形質と強い関連性を認めたが，一方でM癌は腸型形質が多かった．さらに未分化型癌はSM癌，進行癌には認められたが，M癌はすべて分化型癌であった．Vater乳頭口側の胃型形質を持つ非乳頭部十二指腸癌は，早期にSM以深浸潤癌へと進展する可能性を持った悪性度の非常に高い腫瘍であると考えられる．

　Although submucosal invasive nonampullary duodenal carcinoma is an early and important stage of invasive carcinoma, information on clinicopathological characteristics is limited due to the rarity of the disease. We compared the clinicopathological characteristics, including mucin phenotypes, of submucosal invasive carcinoma（SM-Ca）, mucosal carcinoma（M-Ca）, and advanced carcinoma（Ad-Ca）. This research examined 165 patients with sporadic nonampullary duodenal carcinomas（SNADCs）from four institutions between January 2003 and December 2018. Of the 165 SNADCs, 11（7%）were categorized as SM-Ca, 70（42%）as M-Ca, and 84（51%）as Ad-Ca. All SM-Ca and most Ad-Ca lesions were found in the oral-Vater ; however, M-Ca lesions were distributed almost evenly between the oral- and anal-Vater. There was no significant difference in tumor diameter between M-Ca and SM-Ca. However, 45%（5/11）of SM-Ca were ≤10mm. A total of 73%（8/11）of SM-Ca were categorized as gastric phenotype, with no lesions classified as intestinal phenotype ; however, the majority of M-Ca were classified as intestinal phenotype（67%, 8/12）. In contrast to M-Ca, SM-Ca was strongly linked to the oral-Vater and gastric mucin phenotype, implying that the carcinogenesis pathway differs between mucosal and invasive carcinomas based on tumor location and mucin phenotype.