十二指肠上皮性肿瘤的临床病理特征：聚焦具有胃黏液表型的肿瘤（幽门腺型肿瘤）。
Clinicopathological characteristics of duodenal epithelial neoplasms: Focus on tumors with a gastric mucin phenotype (pyloric gland-type tumors).
作者信息
Mitsuishi Takehiro, Hamatani Shigeharu, Hirooka Shinichi, Fukasawa Nei, Aizawa Daisuke, Hara Yuko, Dobashi Akira, Goda Kenichi, Fukuda Takahiro, Saruta Masayuki, Urashima Mitsuyoshi, Ikegami Masahiro
机构信息
Department of Pathology, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
Department of Endoscopy, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan.
出版信息
PLoS One. 2017 Apr 4;12(4):e0174985. doi: 10.1371/journal.pone.0174985. eCollection 2017.
OBJECTIVE
Epithelial tumors less commonly occur in the duodenum than in the stomach or large intestine. The clinicopathological characteristics of duodenal epithelial tumors remain a matter of debate. We therefore studied resected specimens to investigate the clinicopathological characteristics of duodenal epithelial tumors.
MATERIALS AND METHODS
Among duodenal epithelial tumors resected endoscopically or surgically in our hospital, we studied the clinicopathological characteristics of 110 adenomas or intramucosal carcinomas. The grade of atypia of all tumors was classified into 3 groups according to the World Health Organization (WHO) 2010 classification. The tumors were immunohistochemically evaluated to determine the frequency of differentiation toward fundic glands.
RESULTS
As for patient characteristics, there were 76 men (75.2%) and 25 women (24.8%), with a median age of 65 years (range, 34 to 84). The tumors most commonly arose in the first to second part of the duodenum. Many lesions were flat, and the median tumor diameter was 8.0 mm. The lesions were classified into 2 types according to mucin phenotype: intestinal-type tumors (98 lesions, 89.1%) and gastric-type tumors (12 lesions, 10.9%). Intestinal-type tumors were subdivided into 2 groups: tubular-type tumors (91 lesions, 82.7%) and tubulovillous-type tumors (7 lesions, 6.4%). Gastric-type tumors were classified into 2 types: foveolar type (3 lesions, 2.7%) and pyloric gland-type (PG) tumors (9 lesions, 8.2%). The grade of atypia was significantly higher in gastric-type tumors (p<0.01). PG tumors were gastric-type tumors characterized by pyloric glands and findings suggesting differentiation toward fundic glands.
CONCLUSIONS
About 10% of the duodenal tumors had a gastric-type mucin phenotype. Gastric-type tumors showed high-grade atypia. In particular, PG tumors showed similarities to PG tumors of the stomach, such as differentiation toward fundic glands.
目的
上皮性肿瘤在十二指肠的发生率低于胃或大肠。十二指肠上皮性肿瘤的临床病理特征仍存在争议。因此，我们研究了切除标本以探讨十二指肠上皮性肿瘤的临床病理特征。
材料与方法
在我院经内镜或手术切除的十二指肠上皮性肿瘤中，我们研究了110例腺瘤或黏膜内癌的临床病理特征。根据世界卫生组织（WHO）2010年分类，将所有肿瘤的异型性分级分为3组。对肿瘤进行免疫组织化学评估，以确定向胃底腺分化的频率。
结果
患者特征方面，男性76例（75.2%），女性25例（24.8%），中位年龄65岁（范围34至84岁）。肿瘤最常见于十二指肠第一至第二部分。许多病变为扁平状，中位肿瘤直径为8.0mm。根据黏液表型，病变分为2型：肠型肿瘤（98例，89.1%）和胃型肿瘤（12例，10.9%）。肠型肿瘤再细分为2组：管状型肿瘤（91例，82.7%）和管状绒毛型肿瘤（7例，6.4%）。胃型肿瘤分为2型：小凹型（3例，2.7%）和幽门腺型（PG）肿瘤（9例，8.2%）。胃型肿瘤的异型性分级明显更高（p<0.01）。PG肿瘤是具有幽门腺且有向胃底腺分化表现的胃型肿瘤。
结论
约10%的十二指肠肿瘤具有胃型黏液表型。胃型肿瘤显示高级别异型性。特别是，PG肿瘤与胃的PG肿瘤有相似之处，如向胃底腺分化。
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