Desmoplastic reactionを伴った粘膜下層浸潤胃型十二指腸癌の1例

Gastric-type Submucosal Invasive Duodenal Adenocarcinoma with Apparent Desmoplastic Stromal Reactions, Report of a Case

要旨●患者は80歳代，女性．心窩部痛の精査目的のためEGDを施行したところ，十二指腸下行部，乳頭対側のやや口側に20mm大の平皿様の隆起性病変を認めた．病変辺縁は上皮下腫瘍様の立ち上がりを呈し，中央は発赤が目立った．NBI拡大観察では，病変中央の乳頭顆粒状の増殖を呈する領域と，病変辺縁の管状構造を呈する領域を認めた．乳頭顆粒状の増殖を呈する領域は，大小不同の表面微細構造を呈し，窩間部の開大を認めた．粘膜下層浸潤胃型十二指腸癌と診断し，患者のperformance statusを考慮して外科的局所切除術を施行した．病理組織学的所見からtubular adenocarcinoma（tub1>pap），gastric-Brunner gland type，pT1b（SM），Ly0，V0，pHM0，pVM0と診断した．粘膜下層浸潤部で明らかなdesmoplastic reactionを伴っていた．

　An 80s woman presented with mild epigastralgia. EGD（esophagogastroduodenoscopy）revealed a reddish elevated lesion that developed like a submucosal tumor with a shallow depression, measuring 〜20mm in diameter, located in the second portion of the duodenum, just proximal to the papilla of Vater. EGD with magnified narrow-band imaging revealed irregular villous or papillary structures on the surface of the lesion. Based on the findings of endoscopy, a diagnosis of a gastric-type duodenal adenocarcinoma invading the submucosa was made. We performed a local wedge resection without regional lymph node dissection, considering the patient's advanced age and overall health status. Pathological examinations of the resected specimen showed tumors with a tubular or papillary structure consisting of cuboidal and columnar cells with lobule-like glands, spread throughout the mucosa and partially invading the submucosa with apparent desmoplastic stromal reactions. The final diagnosis after histopathology was tubular adenocarcinoma（tub1>pap）, gastric-Brunner gland type, pT1b（SM）, Ly0, V0, pHM0, pVM0. Our case demonstrates the very early process of submucosal invasion of gastric-type adenocarcinomas of the duodenum, with apparent desmoplastic stromal reactions.