Nakatsubo N, Kashiwagi H, Okumura M, Kamoshida T, Takahashi A, Spigelman A D
Department of Surgery, Hitachi General Hospital, Ibaraki, Japan.
Am J Gastroenterol. 1998 Sep;93(9):1566-8. doi: 10.1111/j.1572-0241.1998.00485.x.
Patients with FAP (familial adenomatous polyposis) are known to be at high risk for duodenal cancer. Although the adenoma-carcinoma sequence is thought to exist in the duodenum, clinical observation of the development of duodenal adenoma to cancer has rarely been reported. We outline a 44-yr-old postcolectomy man with FAP who underwent regular gastroduodenoscopy annually or biannually and was found to be harboring duodenal ampullary cancer 5 yr after colectomy. Endoscopic and pathological examination of the ampullary lesion during these 5 yr revealed progression of pathology from adenoma to carcinoma. Pathology of the surgical specimen confirmed ampullary cancer. This in vivo demonstration of the adenoma-carcinoma sequence highlights the current limitations of duodenal surveillance in FAP.
已知家族性腺瘤性息肉病（FAP）患者患十二指肠癌的风险很高。尽管认为十二指肠存在腺瘤-癌序列，但十二指肠腺瘤发展为癌症的临床观察报告很少。我们概述了一名44岁接受结肠切除术后的FAP男性患者，他每年或每两年接受一次常规胃十二指肠镜检查，在结肠切除术后5年被发现患有十二指肠壶腹癌。在这5年中对壶腹病变进行的内镜和病理检查显示病理从腺瘤进展为癌。手术标本的病理证实为壶腹癌。这种腺瘤-癌序列的体内证明突出了目前FAP十二指肠监测的局限性。
