Department of Internal Medicine, Nagasaki Municipal Hospital, Nagasaki, Japan.
Med Sci Monit. 2009 Dec;15(12):CS169-73.
Adenoma of the major papilla carries a relatively high risk of malignant transformation to carcinoma, the leading cause of death in patients with familiar adenomatous polyposis (FAP) after colectomy.
A 35-year-old man had undergone prophylactic colectomy for FAP 3 years earlier. On the forward-viewing and side-viewing endoscopy done for surveillance, the overlying mucosa of the major papilla showed even granularity. On magnifying duodenoscopy using a narrow-band system (NBI), which uses modified optical filters and yields clear images of fine surface structures on the mucosal layer, a compact formation of round pits was seen in the affected ampulla. The microvascular architecture on NBI magnification showed no abnormalities, such as dilated, tortuous or network-like vessels, suggestive of malignancy. On endoscopic retrograde pancreaticocholangiography there was no intraductal growth, and endoscopic ultrasonography showed confinement to the mucosal layer. The ampullary lesion was completely resected using endoscopic snare papillectomy. Histopathological examination of the removed specimen showed tubular adenoma without malignant foci. The patient's post-treatment course was uneventful and without complications, and no local recurrence was noted on repeat endoscopy.
Thus, endoscopic surveillance and removal of ampullary adenomas appear to be justified.
主要乳头腺瘤恶性转化为癌的风险相对较高，这是家族性腺瘤性息肉病（FAP）患者结肠切除术后死亡的主要原因。
一名 35 岁男性 3 年前因 FAP 行预防性结肠切除术。在进行监测的前视和侧视内镜检查中，主要乳头的黏膜表面呈现均匀的颗粒状。使用窄带成像系统（NBI）进行放大十二指肠镜检查时，该系统使用改良的光学滤波器，可以清晰地显示黏膜层的精细表面结构，在受影响的壶腹处可见圆形凹陷的紧密排列。NBI 放大后的微血管结构没有异常，如扩张、扭曲或网状血管，提示恶性肿瘤。经内镜逆行胰胆管造影术（ERCP）未见管内生长，内镜超声检查显示局限于黏膜层。使用内镜套扎乳头切除术完全切除了壶腹病变。切除标本的组织病理学检查显示管状腺瘤无恶性病灶。患者的治疗后过程顺利，无并发症，重复内镜检查未见局部复发。
因此，对壶腹腺瘤进行内镜监测和切除似乎是合理的。
