Extra-ampullary duodenal adenoma: a clinicopathological study
Extra-ampullary duodenal adenoma: a clinicopathological study
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DOI：
10.1111/his.13192
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发表时间：
2017-08-01
期刊：
影响因子：
6.4
通讯作者：
Shibuya, Kazutoshi
中科院分区：
文献类型：
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作者：
Hijikata, Kazunori;Nemoto, Tetsuo;Shibuya, Kazutoshi
壶腹外十二指肠腺瘤 (EADA) 是一种罕见疾病，其临床病理学细节描述甚少。在这项研究中，我们的目的是描述 EADA 的临床病理学特征。方法和结果我们对 44 例 EADA 连续病例进行了回顾性分析。每个 EADA 被分为胃型 (n = 5) 或肠型 (n = 39)。所有胃型腺瘤均位于十二指肠第一部分，呈带蒂形状。胃型腺瘤分为两种亚型：幽门腺瘤和小凹腺瘤。前者由覆盖有 MUC5AC 阳性细胞的粘蛋白 6 (MUC6) 阳性腺体组成，而后者几乎全部由 MUC5AC 阳性细胞组成。当 EADA 分为高等级和低等级时，大约 40%（44 个中的 16 个）为高等级。高级别腺瘤明显大于低级别腺瘤（19.4 ± 8.6 mm vs 11.8 ± 5.1 mm，P = 0.021），所有最大直径大于20 mm的腺瘤均被归类为高级别腺瘤。在十二指肠粘膜切除前后接受全结肠镜检查的 16 例患者中，9 例患有结直肠肿瘤，所有 9 例十二指肠病变均为肠表型。结论我们阐明了胃型和肠型 EADA 的临床病理特征。最大直径大于 20 毫米的 EADA 始终为高级别，并且被认为有可能进展为腺癌。这些发现应该有助于 EADA 的临床管理。
AimsExtra-ampullary duodenal adenoma (EADA) is a rare condition with poorly described clinicopathological details. In this study, we aimed to characterize EADA clinicopathologically.Methods and resultsWe performed a retrospective review of 44 serial cases of EADA. Each EADA was categorized as either gastric-type (n = 5) or intestinal-type (n = 39). All gastric-type adenomas were located in the first portion of the duodenum and exhibited a pedunculated shape. Gastric-type adenomas were classified into two subtypes: pyloric gland and foveolar. The former consisted of mucin 6 (MUC6)-positive glands covered with MUC5AC-positive cells, whereas nearly all the latter consisted of MUC5AC-positive cells. When EADAs were categorized into high and low grades, approximately 40% (16 of 44) were high-grade. The high-grade adenomas were significantly larger than the low-grade adenomas (19.4 8.6 mm versus 11.8 +/- 5.1 mm, P = 0.021), and all adenomas greater than 20 mm in largest diameter were categorized as high-grade adenomas. Among 16 individuals who underwent total colonoscopy before or after duodenal mucosal resection, nine had a colorectal neoplasm, and all nine duodenal lesions were of the intestinal phenotype.ConclusionsWe clarified the clinicopathological characteristics of gastric- and intestinal-type EADAs. EADAs greater than 20 mm at the largest diameter were consistently high-grade, and are thought to have the potential to progress to adenocarcinoma. These findings should be helpful for the clinical management of EADA.