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文献考察１）：小腸悪性リンパ腫（腹部全体痛シリーズGE29から再掲）
【小腸腫瘍 分類と画像所見】 小腸腫瘍 最近5年間(1995〜1999)の本邦報告例の集計
Author：八尾恒良(福岡大学医学部附属筑紫病院 消化器科), 八尾建史, 真武弘明, 古川敬一, 永江隆, 本村明,
菊池陽介, 高木靖寛, 嶋津剛典, 頼岡誠, 久部高司, 八尾哲史, 西村拓, 蒲池紫乃, 竹下宗範, 永本和洋, 諸隈一平,
櫻井俊弘, 松井敏幸
Source：胃と腸(0536-2180)36巻7号 Page871-881(2001.06)
Abstract：過去5年間の小腸原発性腫瘍の報告例(約480例)を抽出・集計し,20年前の集計と比較した.組織型別頻度は, 癌157例(32.6%), 悪性リンパ腫146例(30.4%), 平滑筋肉腫140例(29.1%), 悪性神経原性腫瘍8例(1.7%), カルチノイド8例(1.7%), その他22例が続き, 組織別悪性腫瘍の明らかな増加傾向はなかった.病変の存在部位は, 良・悪性とも, Treitz靭帯およびBauhin弁より離れた部位で多い傾向にあった.消化管間質性腫瘍における免疫染色が行われた報告は, 1998年度以降では, 約半数の24例(53.3%)であった.前回の集計と比較すると,平滑筋腫の頻度がやや高率であったが, その他,腫瘍の大きさ, 臨床症状などに大差はなかった．
追記：悪性リンパ腫146例中男女比は2.5：１，多発例は21.6％，比較的予後が良いとされる10cm以下が78.6%を占めた．部位は空腸が32.0％，回腸が68.0％（ほとんどがBauhin弁から40cm以内）であった．
文献考察２）：小腸悪性腫瘍129例中悪性リンパ腫は19％，悪性リンパ腫の5年生存率は29%．
Arch Surg. 2002 May;137(5):564-70; discussion 570-1.
Primary cancers of the small bowel: analysis of prognostic factors and results of surgical management.
Talamonti MS, Goetz LH, Rao S, Joehl RJ.
HYPOTHESIS: This study was done to review the clinical presentation, surgical management, pathologic features, and prognostic factors for primary small-bowel cancers. DESIGN: Retrospective case series. SETTING: Tertiary care, university hospital. PATIENTS: One hundred twenty-nine patients were surgically treated between January 1, 1977, and December 31, 2000. There were 73 men and 56 women, with a median age of 55 years (age range, 19-82 years). Median follow-up was 36 months. MAIN OUTCOME MEASURES: Presenting symptoms and signs, operations performed, and surgical pathologic features were analyzed and survival curves were generated. RESULTS: Clinical findings included abdominal pain (63%), vomiting (48%), weight loss (44%), and gastrointestinal tract bleeding (23%). The distribution of tumors by histological features was as follows: adenocarcinoma (33%), carcinoid tumor (29%), lymphoma (19%), and sarcoma (19%). Cumulative 5-year survival rate was 37% in the adenocarcinoma group, 64% in the carcinoid tumor group, 29% in the lymphoma group, and 22% in the sarcoma group. Significant prognostic predictors of overall survival for the entire cohort and for each tumor subtype included complete resection and American Joint Committee on Cancer tumor stage (P<.05 patient age tumor location histological grade and use of chemotherapy radiation therapy did not significantly influence survival. curative resections were accomplished in patients with a median survival months compared undergoing incomplete or palliative adjacent organ resection was required the potentially resections. time to recurrence months. twenty-one developed associated primary cancers. conclusions: aggressive surgical an attempt achieve complete removal seems warranted. despite high-stage tumors remain at risk for recurrence.pmid:> |
