十二指腸の腫瘍・腫瘍様病変の病理

Primary Duodenal Tumors and Tumor-like Lesions, Focused on Their Incidence and Brunner's Gland Adenoma.

要旨　内視鏡生検ないし切除の原発性十二指腸腫瘍・腫瘍様病変（乳頭部病変を除く）の77/103（74.8％）は異所性胃粘膜，Brunner腺過形成などの腫瘍様病変で占められ，上皮性腫瘍は21/103（20.4％），非上皮性腫瘍は5/103（4.8％）であった．上皮性腫瘍では腺癌が11/21（52.4％），腺腫が8/21（38.1％）を占め，非上皮性腫瘍は4/5（80.0％）が悪性リンパ腫であった．部位別の病変頻度では，第1部の63/72（87.5％）は腫瘍様病変であった．しかし第2部では腫瘍が16/30（53.3％）を占め，その内訳は腺癌9/30（30.0％），腺癌4/30（13.3％）であり，第2部に病変を認めた場合は，腺癌・腺腫を念頭に置く必要が示された．外科切除例，内視鏡切除例合わせて3例のBrunner腺腫瘍を経験した．3例ともに正常Brunner腺・過形成とは明らかに異なる組織形態像を示し，Ki-67染色により高い細胞増殖能がみられた．これらの病変は，従来は存在しないと考えられてきたBrunner腺の真の腺腫と考えられ，うち1例はBrunner腺腺癌と想定される異型の強い領域を伴っていた．

　We studied on the incidence of primary duodenal tumors and tumor-like lesions excluding tumors of the papilla Vater. The incidence of each type was as follows: heterotopic gastric mucosa and Brunner's gland hyperplasia; 77/103 (74.8%), epithelial neoplasm; 21/103 (20.4%), non-epithelial neoplasm; 5/103 (4.8%). Epithelial neoplasm was composed of adenocarcinoma (11/21, 52.4%) and adenoma (8/21, 38.1%) and most of non-epithelial neoplasm (4/5, 80%) was malignant lymphoma. Most of the lesions in the first portion was tumor-like lesions (63/72, 87.5%), but 53.3% of those in the second portion (16/30) was neoplasm which consisted of adenocarcinoma (9/30, 30%) and adenoma (4/30, 13.3%). Therefore, endoscopists should suspect a lesion in the second portion of the duodenum to be neoplastic.

　We had three cases of Brunner's gland neoplasia examined for histological characteristics and proliferating activity. All of three lesions had histological atypic and higher proliferating activity than normal and hyperplastic Brunner's gland, which were demonstrated by Ki-67 staining. These lesions were thought to be true Brunner's gland adenomas which had not believed to exist. Furthermore, one of them had an area with severe atypia suggesting Brunner's gland carcinoma.