家族性大腸腺腫症に伴う十二指腸腺腫の取り扱い

Management of Duodenal Lesions in Patients with Familial Adenomatous Polyposis

要旨●十二指腸病変の経過が追えた家族性大腸腺腫症40例を対象に，乳頭部腺腫と十二指腸腺腫症の内視鏡所見および病理組織像の経時的推移（中央値12.7年）を検討した．初回検査では31例で乳頭部腺腫が確認された．最終観察時までに乳頭部腺腫を新たに2例で認め，6例で乳頭部の形態変化が出現したが，病理組織学的にはいずれも中等度異型の管状腺腫であった．一方，十二指腸腺腫症は初回検査で全例陽性で，大部分は多発する褪色調の小隆起ないし陥凹性病変として認識された．最終観察時には6例がSpigelman分類Stage IVに分類されたが，病理組織学的には高度異型腺腫を1例に認めるのみで，腺癌の出現はなかった．以上より，本症の十二指腸病変の進行は緩徐であり，癌化もまれと考えられた．

　We retrospectively investigated the endoscopic and pathological features and clinical course of ampullary and non-ampullary adenoma of the duodenum in 40 patients with familial adenomatous polyposis. During initial endoscopy, ampullary adenoma was detected in 31 patients. During follow-up, it was newly diagnosed in two patients. Although there were serial endoscopic features in the ampullary adenoma of six patients, their histological grade of dysplasia remained unchanged. Duodenal adenomatosis was observed in all the 40 patients, and endoscopic findings were characterized by multiple small protrusions or depressed lesions. At the end of follow-up, the grade of duodenal adenomatosis progressed to Spigelman's stage IV in six patients. Severe dysplasia developed in one patient, whereas duodenal cancer was not observed in any patient. The present study reconfirmed the static and benign nature of duodenal adenomatosis in patients with familial adenomatous polyposis.