{"created":"2023-07-26T01:10:59.348233+00:00","id":2001049,"links":{},"metadata":{"_buckets":{"deposit":"012cd1c2-d837-4b51-8e34-0d2141653dba"},"_deposit":{"created_by":4,"id":"2001049","owners":[4],"pid":{"revision_id":0,"type":"depid","value":"2001049"},"status":"published"},"_oai":{"id":"oai:niigata-u.repo.nii.ac.jp:02001049","sets":["453:455","471:561:562"]},"author_link":[],"item_6_date_granted_51":{"attribute_name":"学位授与年月日","attribute_value_mlt":[{"subitem_dategranted":"2023-03-23"}]},"item_6_degree_grantor_49":{"attribute_name":"学位授与機関","attribute_value_mlt":[{"subitem_degreegrantor":[{"subitem_degreegrantor_language":"ja","subitem_degreegrantor_name":"新潟大学"},{"subitem_degreegrantor_language":"en","subitem_degreegrantor_name":"Niigata 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(MSI)について検索した。十二指腸は部位によりBrunner腺の存在による構造的特徴が異なり、組織発生も異なる可能性があるため、Vater乳頭の口側30例と肛門側14例とに分けた検討を行った。Vater乳頭口側の癌では深達度pT4b症例の頻度が有意に高く(P=0.0046)、分化型腺癌の頻度が有意に低く(P=0.041)，神経侵襲陽性率が有意に高かった(P=0.0034)。粘液形質の検討では、十二指腸癌の45%が胃型、20%が胃腸混合型、5%が小腸型、14%が大腸型、16%が粘液欠失型であったが、Vater乳頭口側の癌は肛門側の癌に比べ胃型が有意に高頻度(P=0.029)であった。KRAS変異を48%、GNAS変異を15%、BRAF変異を8%の症例で認めた。p53蛋白過剰発現は25%、CIMP+は35%、MSI-Hは15%であった。GNAS変異、BRAF変異はVater乳頭口側の癌でのみ認められ、GNAS変異症例はMUC6発現陽性症例が多く、Vater乳頭口側発生癌では、Brunner腺、胃腺窩上皮化生、異所性胃粘膜などを発生母地とするものが存在すると推定された。一方Vater乳頭肛門側発生癌では、adenoma-carcinoma sequenceによる発癌も想定されたが、十二指腸癌全体でみてもBRAF変異、CIMP+、MSI-Hの併存例はなく、大腸にみられるserrated neoplasia pathwayをたどるものは極めて稀と考えられた。以上のことから、十二指腸癌はVater乳頭口側か肛門側かにより、組織発生や発癌機序が異なる可能性が示唆された。","subitem_description_language":"ja","subitem_description_type":"Abstract"}]},"item_6_description_53":{"attribute_name":"学位記番号","attribute_value_mlt":[{"subitem_description":"新大院博(医)第1102号","subitem_description_language":"ja","subitem_description_type":"Other"}]},"item_6_dissertation_number_52":{"attribute_name":"学位授与番号","attribute_value_mlt":[{"subitem_dissertationnumber":"甲第5111号"}]},"item_access_right":{"attribute_name":"アクセス権","attribute_value_mlt":[{"subitem_access_right":"open access","subitem_access_right_uri":"http://purl.org/coar/access_right/c_abf2"}]},"item_creator":{"attribute_name":"著者","attribute_type":"creator","attribute_value_mlt":[{"creatorNames":[{"creatorName":"近藤, 修平","creatorNameLang":"ja"},{"creatorName":"Kondo, Shuhei","creatorNameLang":"en"}]}]},"item_files":{"attribute_name":"ファイル情報","attribute_type":"file","attribute_value_mlt":[{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2023-07-26"}],"displaytype":"detail","filename":"r4nmk1102.pdf","filesize":[{"value":"2.66MB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"本文","objectType":"fulltext","url":"https://niigata-u.repo.nii.ac.jp/record/2001049/files/r4nmk1102.pdf"},"version_id":"3dc32068-e4cc-4f9d-b374-c1cce23253d0"},{"accessrole":"open_access","date":[{"dateType":"Available","dateValue":"2023-07-26"}],"displaytype":"detail","filename":"r4nmk1102_a.pdf","filesize":[{"value":"527KB"}],"format":"application/pdf","licensetype":"license_note","mimetype":"application/pdf","url":{"label":"要旨","objectType":"abstract","url":"https://niigata-u.repo.nii.ac.jp/record/2001049/files/r4nmk1102_a.pdf"},"version_id":"d4deca7a-2fc4-42b5-9f0b-d31c47b1505e"}]},"item_keyword":{"attribute_name":"キーワード","attribute_value_mlt":[{"subitem_subject":"十二指腸癌","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"粘液形質","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"免疫染色","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"遺伝子変異","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"臨床病理","subitem_subject_language":"ja","subitem_subject_scheme":"Other"},{"subitem_subject":"分子病理","subitem_subject_language":"ja","subitem_subject_scheme":"Other"}]},"item_language":{"attribute_name":"言語","attribute_value_mlt":[{"subitem_language":"jpn"}]},"item_resource_type":{"attribute_name":"資源タイプ","attribute_value_mlt":[{"resourcetype":"doctoral 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