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Clinicopathological Features and Treatment Strategies for Submucosal Invasive Non-ampullary Duodenal Adenocarcinoma Shoichi Yoshimizu 1 , Hiroshi Kawachi 2,3 , Yorimasa Yamamoto 4 , Kaoru Nakano 2,3 , Manabu Takamatsu 2,3 , Yusuke Horiuchi 1 , Akiyoshi Ishiyama 1 , Toshiyuki Yoshio 1 , Toshiaki Hirasawa 1 , Hiromichi Ito 5 , Junko Fujisaki 1 1Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 2Department of Pathology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 3Division of Pathology, Cancer Institute, Japanese Foundation for Cancer Research, Tokyo 4Department of Gastroenterology, Showa University Fujigaoka Hospital, Endoscopy Center, Yokohama, Japan 5Department of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo Keyword: 非乳頭部十二指腸SM癌 , 臨床病理学的特徴 , リンパ節転移率 , 治療方針 , リンパ節転移リスク因子 pp.1671-1683
Published Date 2021/12/25
DOI https://doi.org/10.11477/mf.1403202618
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 This study aimed to clarify clinicopathological features and treatment strategies for submucosal invasive NADAC(non-ampullary duodenal adenocarcinoma). We retrospectively reviewed 188 lesions with superficial NADAC treated at our institution ; of these, 173 had intramucosal(M-)and 15 had submucosal(SM-)NADAC. On comparing the endoscopic features, tumor location proximal to the papilla(SM:86.7% vs. M:49.1%), reddish color lesions(SM:80% vs. 53.2%), and mixed macroscopic type(0-IIa+IIc or 0-IIa+I)(SM:53.3% vs. M:6.9%)were found to be significantly more frequent in SM-NADAC than in M-NADAC. Regarding histopathological features, poorly differentiated tumor(26.7% vs. 0%)and presence of lymphovascular invasion(46.7% vs. 0%)were significantly more frequent in SM-NADAC than in M-NADAC. Almost all SM-NADAC lesions showed expression of gastric phenotypic markers(MUC5AC and/or MUC6), and the tumor immunophenotype was classified into gastric or mixed phenotype(expression of both gastric and intestinal markers). Six of 14 patients with SM-NADAC developed lymph node metastasis(lymph node metastasis rate:42.9%). Thus, surgical treatment with regional lymph node dissection is recommended as a treatment strategy for SM-NADAC.


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

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