十二指腸非腫瘍性病変の拡大観察

Diagnosis of Non-neoplastic Lesions Using Magnifying Endoscopy with Narrow Band Imaging

要旨●十二指腸非腫瘍性病変の中で，白色化を呈するびまん性病変と胃腺窩上皮を伴う限局性病変（腫瘍様病変）のNBI併用拡大内視鏡所見を，病理組織学的に確定診断が得られた自験例に基づいて検討した．びまん性病変の白色化は，粘膜固有層に存在するリンパ流の停滞や脂肪滴の沈着（撒布性白点），マクロファージの集簇（Whipple病，炭酸ランタン関連病変）などに起因するものであった．この場合，白色化の表層の微小血管は視認可能であり，腸型腺腫にみられるWOSとの鑑別は可能であった．一方，腫瘍様病変の中で典型的な胃小区模様を伴うものは通常観察やNBI併用拡大観察で鑑別診断が可能であったが，十二指腸絨毛との鑑別が困難な症例も存在した．十二指腸非腫瘍性病変において，各疾患の病態や病理学的構築を念頭に置きながら，通常観察に加えNBI併用拡大観察によって表面構造や微小血管の有無，絨毛の外形に着目することがその鑑別診断に有用となる可能性がある．

　In this study, we aimed to investigate the correlation between the findings of magnifying endoscopy with narrow band imaging and the histological findings of tumor-like lesions and diffuse duodenal lesions with white villi. The colors of diffuse duodenal lesions with white villi are determined by lymph flow stagnation and the presence of many foamy macrophages and lipid droplets in the lamina propria. In such cases, because microvasculature can be detected on the surface of the white villi, we concluded that magnifying endoscopy facilitates the differential diagnosis of diffuse duodenal lesions with white villi and WOS（white opaque substance）in intestinal-type adenoma. Although the endoscopic diagnosis of tumor-like lesions with islands of typical gastric area on the surface is comparatively easy, tumor-like lesions sometimes require a differential diagnosis with respect to other neoplastic tumors. Therefore, careful examination and analysis of correlations between endoscopic findings, such as microvasculature and the shape of villi, and histological findings may be useful for the endoscopic differential diagnosis of duodenal non-neoplastic lesions.