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Endoscopic Diagnosis of Non-ampullary Duodenal Adenomas and Adenocarcinoma Ryosuke Kiyomori 1 , Koichi Kurahara 1 , Yumi Oshiro 2 , Takashi Hirata 1,3 , Koji Ikegami 1 , Yuichi Hara 1 , Takamasa Yoshihara 1 , Shinjiro Egashira 1 , Naonori Imoto 1 , Yoko Minamikawa 1 , Takehiro Torisu 3 1Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan 2Department of Pathology, Matsuyama Red-cross Hospital, Matsuyama, Japan 3Departments of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan Keyword: 十二指腸非乳頭部 , 十二指腸腺腫・癌 , 腸型腫瘍 , 胃型腫瘍 , 内視鏡所見 pp.1637-1652
Published Date 2021/12/25
DOI https://doi.org/10.11477/mf.1403202614
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 Clinical and endoscopic findings of 74 patients with 81 lesions that were definitively diagnosed as non-ampullary duodenal adenoma/adenocarcinoma based on endoscopic or surgical histopathology in our department were retrospectively reviewed. Non-ampullary duodenal adenoma/adenocarcinoma classification by mucin phenotype included 32 intestinal-type tumor lesions of 28 patients(29 adenoma and 3 adenocarcinoma lesions), 12 mixed(intestinal-gastric)-type lesions of 12 patients(8 adenomas, 4 adenocarcinomas), and 37 gastric-type lesions of 34 patients(16 adenoma lesions, 18 neoplasms of uncertain malignant potential, and 3 adenocarcinoma lesions). The 32 intestinal-type tumors were classified macroscopically into 12 0-IIa type lesions(37.5%), 10 0-IIa+IIc type lesions(31.3%), and 10 0-I type lesions(31.3%). The 12 mixed-type tumors were macroscopically classified into 4 0-IIa lesions(33.3%), 2 0-IIa+IIc type lesions(16.7%), and 6 0-I type lesions(50%). The 37 gastric-type tumors were macroscopically classified into 20 submucosal tumor-like elevated lesions(54.0%)and 15 0-I type lesions(40.5%). Further, 40 of the 44 intestinal- and mixed-type tumors(90.9%)were observed to have whitened surface compared with only 6 of the 37 gastric-type lesions(16.2%). On the lesion surface of the gastric-type tumors, areas comprising MUC5AC-positive cells with gastric crypt epithelization were identified in 35 of 37 lesions(94.6%). Intestinal-type tumors were often whitened, relatively flat, surface-type lesions, whereas the gastric-type tumors were frequently observed as crypt epithelium sheet-like areas of relatively highly elevated lesions. It is not always easy to endoscopically differentiate between gastric-type tumors and tumor-like lesions with ectopic gastric-type epithelium. However, there have been no cases in which biopsy-linked fibrosis hampered an endoscopic resection owing to the abundance of lesions with an elevated aspect. The potential presence of tumorous lesions was noted in all patients who underwent biopsy ; thus, histopathological assessment by biopsy was considered effective for differentiating between tumor-like lesions and gastric-type tumors.


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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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