十二指腸乳頭部生検病理の問題点

Histological Problems of Endoscopical Biopsy from Vater's Papilla

要旨　十二指腸ファイバースコープの機種改良と普及は，十二指腸乳頭部癌の早期発見に寄与するところ多大である．国立がんセンターで施行された十二指腸生検1,039検体を対象とし，術前生検と手術後の組織診断とを対比し検討した．その結果，問題点が幾つか浮き彫りにされた中で，まず第1に重要な問題は高分化型癌の偽陽性診断が起こることである．この部の癌は分化型腺癌が多く，これらと良性の腺腫との鑑別は，組織学的に甚だ困難なことがある．次に問題となるのは，標本が十分採取されていないことである．したがって，十二指腸乳頭部早期癌の診断精度を向上させるためには，集検などで異常が発見された場合には，臨床医はもちろん病理医も積極的な態度で診断に当たることが肝要である．

　With the recent improvement of duodenal fiberscope, duodenal endoscopic examination has become much easier and been more frequently performed than before. However, early detection of malignant tumor of the duodenal Vater's papilla is still infrequent. Under these circumstances, histological diagnosis made using endoscopic biopsy specimen contributes in a great deal to the preoperative diagnosis of lesions of the duodenal Vater's papilla. On the other hand, several problems in histological diagnosis have been pointed out and encountered in the routine examinations. The most important of these is false negative diagnosis for very well differentiated tubular and/or papillary adenocarcinoma commonly seen in this region. It is often difficult to differentiate carcinoma from adenoma or hyperplastic lesion. The difficulty may be attributed in part to poor experience because lesions of the Vater's papilla are rarely encountered in daily practice. Although malignant lesions of the duodenum are not so frequent as described in the text. It is important to take a close look at the duodenum in routine alimentary tract examination or screening test and to take a biopsy from the Vater's papilla in case of any abnormal findings.

　It is also important and necessary for practicing physicians treating patients to have knowledge about histologically benign looking but malignant lesion in this region.