腫瘍性・腫瘍様十二指腸小病変の診断―腺腫・癌

Diagnosis of Neoplastic and Neoplastic-like Duodenal Small Lesions, Adenoma and Cancer

要旨　1990年1月から2000年12月までに経験した十二指腸腺腫および癌43例(腺腫23例，早期癌14例，進行癌6例)のうち20mm以下の21例(10mm以下17例，11mm以上20mm以下4例)について，それらのX線・内視鏡所見および病理組織学的所見について検討した．10mm以下は腺腫13例，早期癌4例，11mm以上20mm以下は腺腫2例，早期癌2例であり，腺腫はその大部分が白色調，微細顆粒状ないし結節状の無茎性隆起(Ⅰs型，Ⅱa型)を占め，後者は腺腫と同様の形状あるいはⅡc型で，赤色調ないし同色調を呈した．鑑別疾患として，2つのタイプを挙げ，隆起全体が正常と異なる上皮性病変の型は異所性胃粘膜が，まれながら粘膜下腫瘍様隆起で頂部に上皮性ないしびらん性変化を来す型は異所性胃粘膜，カルチノイド，転移性腫瘍，などが主に挙げられた．

　We experienced 43 duodenal adenomas and cancers (23 cases of adenoma, 14 cases of early cancer, 6 cases of advanced cancer) during the period between January 1990 and December 2000. We investigated 21 lesions whose diameter was less than 20 mm in size (17 cases were less than 10 mm in size and 4 cases were between 11 and 20 mm in size) from the radiologic, endoscopic and patho-histological viewpoints. There were 13 cases of adenoma and 4 cases of early cancer in the group of lesion less than 10 mm in size, 2 cases of adenoma and 2 cases of early cancer in the group of lesion between 11 and 20 mm in size. Most of the adenoma was a whitish-colored nodular or micro-granular surfaced sessile elevation (type Is or type IIa), whereas the shape of cancer was the same as adenoma or type IIc and the surface was reddish-colored with erosion. Differential diagnosis of the neoplastic lesion was divided into 2 types: one was a elevated lesion fully covered with abnormal epithelium, which was commonly diagnosed as ectopic gastric mucosa, and the other was not so common type and a submucosal tumor-like elevation with epithelial or erosive changes on the top, which was diagnosed as ectopic gastric mucosa, carcinoid, metastatic tumor or malignant lymphoma.