Bertoni G, Sassatelli R, Nigrisoli E, Pennazio M, Tansini P, Arrigoni A, Ponz de Leon M, Rossini F P, Bedogni G
Digestive Endoscopy Service, S. Maria Nuova Hospital, Reggio Emilia, Italy.
Eur J Gastroenterol Hepatol. 1996 Dec;8(12):1201-6. doi: 10.1097/00042737-199612000-00013.
Patients with familial adenomatous polyposis (FAP) are traditionally considered to be at high risk for duodenal-papillary and periampullary adenomas and cancer.
To evaluate prospectively the prevalence, histology and clinical significance of ampullary and periampullary macroscopic and microscopic lesions in our population of affected patients.
Three gastroenterological departments of northern Italian hospitals.
Twenty-five affected patients were carefully investigated over a 24-month period by end-viewing and side-viewing upper panendoscopy. Biopsies were performed on representative macroscopic lesions and randomly on normal-appearing papillary and periampullary mucosa.
Seven patients had macroscopic adenomas of the duodenal papilla, three of the periampullary region and five at both sites (cumulative prevalence 40%). An additional six patients had macroadenomas in the rest of the duodenum (overall prevalence 64%). Microscopic adenomas were identified in nine and two patients in the papilla and periampullary region, respectively, and in three at both sites (overall prevalence 44%). Thus, a total of 17 (68%) patients presented macro- or microadenomas at these locations. The prevalence rose to 72%, when a further patient with macroadenomas in the rest of the duodenum only was included. Malignancy was not encountered and severe dysplasia was observed only in a macroadenoma of the second duodenal portion. A higher frequency of macroadenomas in the papilla and periampullary region was significantly correlated with the presence and number of such lesions in the rest of the duodenum (P = 0.04). No other significant association was detected either between micro- or macroadenomas at different sites or with the demographic, clinical and pathological features.
This study confirms that the duodenal papilla and periampullary region are sites with high prevalence of macro- and microscopic adenomas in patients with FAP. However, our data do not seem to support a higher frequency and malignancy potential of such lesions as compared to polyps in the rest of the duodenum. Nevertheless, these findings warrant a periodic, careful examination of the duodenum with either end-viewing or side-viewing endoscopy, the need for random biopsies of the papilla and periampullary region and the removal of any larger or rapidly growing lesions detected.
家族性腺瘤性息肉病（FAP）患者传统上被认为十二指肠乳头和壶腹周围腺瘤及癌症的高危人群。
前瞻性评估我们所研究的患病人群中壶腹和壶腹周围肉眼及显微镜下病变的患病率、组织学特征及临床意义。
意大利北部医院的三个胃肠病科。
在24个月期间，对25例患者进行了细致的检查，采用直视和侧视上消化道内镜检查。对有代表性的肉眼病变进行活检，并随机对外观正常的乳头和壶腹周围黏膜进行活检。
7例患者十二指肠乳头有肉眼可见的腺瘤，3例壶腹周围区域有腺瘤，5例两处均有（累积患病率40%）。另外6例患者十二指肠其他部位有大腺瘤（总体患病率64%）。在乳头和壶腹周围区域分别有9例和2例患者发现显微镜下腺瘤，3例两处均有（总体患病率44%）。因此，共有17例（68%）患者在这些部位出现了肉眼或显微镜下腺瘤。若将仅在十二指肠其他部位有大腺瘤的1例患者纳入，患病率升至72%。未发现恶性病变，仅在十二指肠第二段的一个大腺瘤中观察到重度发育异常。乳头和壶腹周围区域大腺瘤的较高发生率与十二指肠其他部位此类病变的存在及数量显著相关（P = 0.04）。在不同部位的显微镜下或肉眼腺瘤之间，以及与人口统计学、临床和病理特征之间，均未发现其他显著关联。
本研究证实，十二指肠乳头和壶腹周围区域是FAP患者中肉眼和显微镜下腺瘤患病率较高的部位。然而，我们的数据似乎并不支持与十二指肠其他部位息肉相比，此类病变有更高的发生率和恶性潜能。尽管如此，这些发现仍需定期通过直视或侧视内镜对十二指肠进行仔细检查，对乳头和壶腹周围区域进行随机活检，并切除任何发现的较大或快速生长的病变。
