十二指腸の腫瘍・腫瘍様病変の病理診断―腺腫と癌の診断基準と臨床病理学的特徴

The Pathological Diagnosis of Duodenal Neoplasms and Neoplasm-like Lesions: Standard Diagnosis and Clinicopathological Characteristics of Adenoma and Carcinoma

要旨　自験十二指腸腺腫，および十二指腸癌（境界悪性病変を含む）を対象とし，臨床病理学的特徴や診断基準の検討を行った．十二指腸腺腫はその多くが腸型だが，異所性胃粘膜やBrunner腺を由来とする病変もある．また，腸型腺腫では細胞分化が比較的豊富にみられる．筆者らは十二指腸腺腫をその組織発生や粘液形質から（1）intestinal type，（2）gastric type，（3）Brunner's gland type，（4）unclassified typeに大別し，さらにintestinal typeは細胞分化の面からa. Paneth cell rich type，b. argentaffin cell rich type，c. intermediate type，d. with endocrine cell nests typeに細分類することを推奨したい．腺腫と境界悪性病変，そして粘膜内癌の組織学的比較では，腺腫はgoblet cell，Paneth cell，argentaffin cellなどの細胞分化が比較的豊富で，基本的に円形，楕円形，もしくは直線的で均一な腺管構造を呈する一方，境界悪性病変や癌は，細胞分化が全くみられなかったり，過剰に認められることがある．そして腺管の蛇行や分岐，癒合などの構造異型や，腺腫ではみられない乳頭状構造などがみられた．

　We studied surgically and endoscopically extracted specimens that were histopathologically examined at the Department of Pathology, Chikushi Hospital, Fukuoka University, Japan, and evaluated standard diagnosis and clinicopathological characteristics of duodenal adenoma（28 lesions）and carcinoma（17 lesions）.

　We had classified adenomas according to tumor origin and mucin phenotype as follows :（1）intestinal type,（2）gastric type,（3）Brunner's gland type,（4）unclassified type, and we had classified intestinal type adenomas according to cell differentiation as follows : a. Paneth cell rich type, b. Argentaffin cell rich type, c. Intermediate type, d. With endocrine cell nests type.

　We thought that the point of discrimination between adenoma and adenocarcinoma（including borderline malignancy lesions）was cell differentiation such as goblet cell,Paneth cell, and argentaffin cell, and the degree of cellular and structural atypia. For example, the adenomatous glands showed cell differentiation of various degree, but carcinomatous glands had no cell differentiation or had it excessively. The glands of adenomas were round, oval, and smooth and regular structures, but carcinomatous glands were irregular structures with brunch and conglutination.