Kido Koyo, Ikenoyama Yohei, Yoshimizu Shoichi, Takamatsu Manabu, Ueki Arisa, Ishiyama Akiyoshi, Yoshio Toshiyuki, Hirasawa Toshiaki, Takahashi Yu, Gotoda Takuji
Department of Gastroenterology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31, Ariake, Koto-Ward, Tokyo, 135-8550, Japan.
Department of Gastroenterology and Hepatology, Mie University Hospital, Mie, Japan.
Clin J Gastroenterol. 2025 Feb;18(1):74-80. doi: 10.1007/s12328-024-02058-y. Epub 2024 Nov 19.
Early-stage, poorly differentiated, non-ampullary duodenal adenocarcinomas are rare, and their clinicopathological features remain unelucidated. Between September 2006 and April 2022, 205 consecutive patients underwent endoscopic or surgical resection for early-stage non-ampullary duodenal adenocarcinomas at our hospital. There were no cases of poorly differentiated adenocarcinoma among the 188 cases of mucosal carcinoma. Meanwhile, among the 17 cases of submucosal invasive carcinoma, four cases were poorly differentiated adenocarcinomas. Herein, we report four cases of these carcinomas. All four lesions were reddish in color and were located on the oral side of the papilla. The gross types were either protruded (0-I) or mixed, elevated, and depressed (0-IIa + IIc). During preoperative diagnosis, submucosal invasion was suspected in all lesions, and biopsies were performed. Based on histological analyses of biopsy specimens, a diagnosis of poorly differentiated or signet-ring cell components was made in all cases, and a pancreaticoduodenectomy was performed. The median tumor size was 6.5 (range, 5-12) mm, and all lesions were poorly differentiated adenocarcinomas with submucosal invasion and lymph node metastasis. Regarding the tumor immunophenotype, one and three cases exhibited gastric and mixed gastrointestinal phenotypes, respectively. Two patients experienced metastatic recurrence; one of them died from the primary disease.
早期、低分化、非壶腹十二指肠腺癌较为罕见，其临床病理特征仍不明确。2006年9月至2022年4月期间，我院连续205例患者因早期非壶腹十二指肠腺癌接受了内镜或手术切除。188例黏膜癌中无低分化腺癌病例。同时，在17例黏膜下浸润癌中，有4例为低分化腺癌。在此，我们报告4例此类癌。所有4个病灶均呈红色，位于乳头口侧。大体类型为隆起型（0-I型）或混合型、隆起伴凹陷型（0-IIa+IIc型）。术前诊断时，所有病灶均怀疑有黏膜下浸润，并进行了活检。根据活检标本的组织学分析，所有病例均诊断为低分化或印戒细胞成分，并进行了胰十二指肠切除术。肿瘤中位大小为6.5（范围5-12）mm，所有病灶均为伴有黏膜下浸润和淋巴结转移的低分化腺癌。关于肿瘤免疫表型，分别有1例和3例表现为胃型和混合型胃肠道表型。2例患者发生转移复发；其中1例死于原发性疾病。
