Division of Gastroenterology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan.
Kaiunbashi Endoscopy Clinic, Morioka, Japan.
Digestion. 2018;97(3):219-227. doi: 10.1159/000485505. Epub 2018 Feb 9.
We aimed to investigate an association between clinicopathological features, including immunohistochemical mucin phenotypes, and magnifying chromoendoscopic findings with crystal violet staining (ME-CV) in non-ampullary duodenal epithelial tumors (NADETs).
A total of 55 patients with NADET were divided into 3 groups by mucin phenotype: intestinal, gastrointestinal, or gastric. ME-CV findings were classified into 4 patterns: convoluted, leaf-like, reticular/sulciolar, and pinecone. The clinicopathological features and ME-CV findings were compared among the mucin phenotypes.
Tumors of the gastric type were located in the duodenal bulb (p < 0.001), and contained pyloric gland adenoma (p < 0.001) more frequently than the other types. White-light endoscopy indicated that milk-white mucosa was less frequent in tumors of the gastric type than in those of the gastrointestinal type (p = 0.006) and the intestinal type (p < 0.001). ME-CV findings were significantly different between the gastric type and the other type (p = 0.028). Totally, 5 of 8 tumors of the gastric type manifested a pinecone pattern, 4 of which were compatible with pyloric gland adenoma.
The endoscopic findings of NADETs differ according to mucin phenotype. A pinecone pattern under ME-CV may be characteristic of NADETs of the gastric type, especially pyloric gland adenoma.
本研究旨在探讨非壶腹十二指肠上皮肿瘤（NADETs）的临床病理特征，包括免疫组织化学黏蛋白表型与结晶紫染色放大 chromoendoscopy （ME-CV）表现之间的关系。
共纳入 55 例 NADET 患者，根据黏蛋白表型分为肠型、胃肠型和胃型 3 组。ME-CV 表现分为卷曲、叶状、网状/沟状和松塔 4 种类型。比较各组间黏蛋白表型与 ME-CV 表现的差异。
胃型肿瘤位于十二指肠球部（p<0.001），且更常包含幽门腺腺瘤（p<0.001）。白光内镜下，胃型肿瘤的乳白样黏膜较胃肠型（p=0.006）和肠型（p<0.001）更为少见。ME-CV 表现也存在显著差异（p=0.028）。胃型肿瘤中，5 例表现为松塔样，其中 4 例与幽门腺腺瘤一致。
NADETs 的内镜表现与黏蛋白表型相关。ME-CV 下的松塔样表现可能是胃型 NADETs 的特征性表现，尤其是幽门腺腺瘤。
