Stomach and Intestine(Tokyo) Volume 54, Issue 8 (July 2019)
Japanese

Clinical and Endoscopic Features of Superficial Non-ampullary Duodenal Epithelial Tumors and Tumor-like Lesions Takashi Hirata 1 , Koichi Kurahara 1 , Yumi Oshiro 2 , Hiroki Yaita 1 , Shohei Uraoka 1 , Yuichiro Yoshida 1 , Hiroshi Wachi 1 , Hitomi Matsuba 1 , Hidetaka Yamamoto 3 1Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan 2Department of Pathology, Matsuyama Red-cross Hospital, Matsuyama, Japan 3Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Keyword: 十二指腸非乳頭部腫瘍 , 十二指腸上皮性腫瘍 , 胃型腫瘍 , 腫瘍様病変 , 内視鏡診断 pp.1103-1120
Published Date 2019/7/25
DOI https://doi.org/10.11477/mf.1403201802
  • Abstract
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 We retrospectively examined the clinical features of superficial non-ampullary duodenal epithelial tumors that were histopathologically diagnosed by endoscopic resection or surgical resection at our department. In total, 17 lesions from 17 cases of duodenal tumor of the intestinal phenotype(15 adenomas and two adenocarcinomas), eight lesions from 8 cases of duodenal tumor of mixed gastric and intestinal phenotype, and 29 lesions from 27 cases of duodenal tumor of the gastric phenotype were diagnosed. We observed duodenal tumors of intestinal phenotype and mixed gastric and intestinal phenotype in the descending portion in 17 cases(68%). Regarding the macroscopic appearance, 13 lesions(52%)were flat and 12(48%)were protruded. WOS(White opaque substance)was detected in 21 lesions(84.0%)in duodenal tumors of the intestinal phenotype and mixed gastric and intestinal phenotype. We observed duodenal tumors of the gastric phenotype in the duodenal bulb in 22 cases(75.9%). Of the 25 duodenal tumors of the gastric phenotype, 17 lesions(58.6%)had submucosal tumor-like morphology and 10(34.5%)were protruded. Duodenal tumors of the gastric phenotype often exhibited gastric-like mucosa on the surface layer.

 Regarding the tumor-like lesions, 7 cases of Brunner's gland hyperplasia and hamartoma, 7 cases of crypt hyperplasia/hyperplastic polyps, and 4 cases of Peutz-Jeghers type polyps were diagnosed using endoscopic resection. Of the 7 cases of Brunner's gland hyperplasia/hamartoma, 4 exhibited submucosal tumor-like morphology and 5 exhibited gastric-like mucosa on the surface layer.

 WOS may be useful for the detection of duodenal tumors of the intestinal phenotype and islands of gastric epithelium on the surface of the protruding lesions may be helpful for the detection of duodenal tumors of gastric phenotype.

 Accurate endoscopic diagnosis of duodenal epithelial tumors and tumor-like lesions is challenging. The macroscopic appearance of duodenal tumor of the gastric phenotype is often protruded and preoperative biopsy diagnosis indicates relatively high accuracy ; therefore, preoperative biopsy might be useful for the differential diagnosis between duodenal epithelial tumors of gastric phenotype and tumor-like lesions.


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基本情報

05362180.54.8.jpg
胃と腸
54巻8号 (2019年7月)
電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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