小腸悪性腫瘍の臨床病理学的特徴―小腸原発性上皮性悪性腫瘍（癌腫）の臨床病理学的検討

Clinicopathological Analysis of Adenocarcinoma of the Small Intestine

要旨　原発性小腸癌19例に対し，臨床病理学的検討を行った．男性11例，女性8例，平均年齢60歳，主訴は通過障害が74％を占め，発症から手術まで平均4か月を要していた．血清CA19-9の上昇が18％にみられた．小腸癌の80％は，Treitz靱帯から30cm以内またはBauhin弁から10cm以内に存在していた．腫瘍の肉眼型では潰瘍限局型（55％）が，組織型では分化型管状腺癌（76％）が多かった．全例，腺腫成分は併存していなかった．癌は全例が漿膜下層以深に達し，リンパ節転移を63％に認めた．粘液組織化学染色ではsialomucinを74％に認めた．免疫組織化学染色ではMUC1陽性例が71％にみられ，陽性群の年齢が陰性群より有意に高くなっていた．MUC2陽性例は41％で，MUC1とは逆に陽性群の年齢が陰性群より有意に低くなっていた．死亡例5例中，他病死した1例を除く死因は癌性腹膜炎であった．

　The purpose of this study was to perform a comprehensive analysis of small intestinal adenocarcinoma with clinicopathologic parameters. The cohort included 11 male and eight female patients with an age range of 34 to 83 years（mean, the average 60 years）. Patients most frequently developed obstruction of food passage（74％）, and it took about 4 months required to confirm the diagnosis. Approximately 80％ of the adenocarcinomas were located within 30cm of the ligament of Treitz and 10cm from Bauhin's valve. The pathological features of the adenocarcinomas showed a tendency toward the localized ulcerating and well differentiated types. None of the cases showed adenomatous components adjacent to the carcinoma. Sialomucins showed sensitivity in 74％ of adenocarcinomas by histochemical staining. Immunohistochemical staining showed MUC1 expression in 71％ of adenocarcinomas, and patients in the MUC1-positive group were significantly older than those in the negative group. In contrast, patients in the MUC2-positive group were significantly younger than those in the negative group. Out of the 19 patients, 4 died of peritoneal dissemination and one died of malignant mesothelioma.