Takahashi Kiichi, Hatta Waku, Koike Tomoyuki, Kanno Takeshi, Ara Nobuyuki, Asanuma Kiyotaka, Asano Naoki, Imatani Akira, Fujishima Fumiyoshi, Sasano Hironobu, Shimosegawa Tooru
Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
Department of Pathology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
Clin J Gastroenterol. 2017 Oct;10(5):469-473. doi: 10.1007/s12328-017-0758-8. Epub 2017 Jun 29.
The number of duodenal neuroendocrine tumors has recently increased, but their natural history has not been well characterized. Here we report the case of a 59-year-old female undergoing complete resection by endoscopic mucosal resection after monitoring endoscopic morphologic changes and the size increment of a duodenal neuroendocrine tumor over the longest follow-up duration. An elevated lesion was initially detected on the duodenal bulb. Endoscopic biopsy from this lesion was performed three times during the follow-up, but all of the specimens simply demonstrated the presence of gastric metaplasia. Thereafter, in the esophagogastroduodenoscopy performed 14 years after the initial examination, a slight depression was detected in the center of the lesion together with an incremental change of its size. The histopathologic diagnosis of neuroendocrine tumor was made by deeper tissue sampling, and the patient subsequently underwent endoscopic mucosal resection for this tumor and was finally diagnosed with a G1 duodenal neuroendocrine tumor with pT2 cN0, cM0, stage IIa in the TNM classification. This is the first case demonstrating the slowly progressive nature of such a tumor with the longest follow-up of a duodenal neuroendocrine tumor ever reported, which could provide important information regarding the natural history and management of such tumors.
十二指肠神经内分泌肿瘤的数量近来有所增加，但其自然病程尚未得到充分描述。在此，我们报告一例59岁女性患者，在对十二指肠神经内分泌肿瘤进行最长时间的随访，监测其内镜形态变化和大小增加情况后，通过内镜黏膜切除术进行了完整切除。最初在十二指肠球部发现一个隆起性病变。在随访期间对该病变进行了3次内镜活检，但所有标本均仅显示存在胃化生。此后，在初次检查14年后进行的食管胃十二指肠镜检查中，病变中心发现轻微凹陷，同时其大小有增大变化。通过更深层组织取样做出神经内分泌肿瘤的组织病理学诊断，患者随后接受了该肿瘤的内镜黏膜切除术，最终被诊断为G1期十二指肠神经内分泌肿瘤，TNM分类为pT2 cN0、cM0，IIa期。这是首例报道的对十二指肠神经内分泌肿瘤进行最长时间随访，证明此类肿瘤具有缓慢进展性质的病例，可为这类肿瘤的自然病程和治疗提供重要信息。
