十二指腸カルチノイド―治療方針について

Duodenal Carcinoid Tumor: Strategy of Treatment

要旨　十二指腸カルチノイドは比較的まれで，緩徐な発育進展様式でありながら，リンパ節郭清を伴う手術を行った場合の侵襲性から治療方針の選択が難しい場合が起こりうる．今回当院で経験した十二指腸カルチノイド21例について検討した．発生部位は球部が17例，腫瘍径は10mm以下が18例であった．外科的切除を9例，内視鏡切除を9例に行い，リンパ節転移，遠隔転移は手術例1例にのみ認めた．平均観察期間67.6か月で，他病死を2例に認めた以外は生存中で，転移症例も担癌状態で3年生存中である．MIB1による細胞増殖能と腫瘍径，深達度には相関がなかった．十二指腸カルチノイドの治療方針としては，腫瘍径10mm以下は内視鏡的切除，20mmを超えるものはリンパ節郭清を伴う切除が推奨され，10～20mmまでの腫瘍および10mm以下でも固有筋層以深の浸潤を示すものは転移の有無，内視鏡的切除標本の病理所見を考慮した治療法が必要と考えられた．

　Duodenal carcinoid tumors are relatively rare. It is difficult to determine a strategy for their treatment. We report a clinicopathologic study of 21 duodenal carcinoid tumors in our hospital. Seventeen cases were observed in the bulbus. Eighteen cases were not more than 10mm in size. For treatment, nine cases were subjected to surgery with lymph node dissection. Nine cases underwent EMR（endoscopic mucosal resection）and three cases have been under follow-up without any treatment. Metastasis to the liver and lymph node was recognized only in one case. Two cases died due to other carcinomas but the others are still living. MIB1 index of the proliferative activity was not correlative with tumor size and depth of invasion. A strategy for treatment for duodenal carcinoid tumor based on the pathological characteristics of EMR specimen and metastasis, was recommended.