Sonoda Hirofumi, Kobayashi Takashi, Endo Yuhei, Irie Shoichi, Hirata Toru, Minamimura Keisuke, Mafune Ken-Ichi, Mori Masaya
Division of Gastrointestinal Surgery, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
Division of Pathology, Mitsui Memorial Hospital, Kanda-Izumi-cho 1, Chiyoda-ku, Tokyo 101-8643, Japan.
Case Rep Med. 2015;2015:986971. doi: 10.1155/2015/986971. Epub 2015 Jan 22.
A 66-year-old Japanese man was referred to our hospital because of suspected duodenal cancer. Upper gastric endoscopy revealed a giant polypoid-type tumor that extended from the duodenum bulb to the pyloric ring. A computed tomography scan revealed a slightly enhanced lobular tumor protruding into the duodenum bulb. Positron emission tomography showed an accumulation of (18)F-fluorodeoxyglucose in the area extending from the antrum of the stomach to the duodenum bulb. Since an endoscopic ultrasound test suggested that the tumor might invade the muscular tunic, indications of endoscopic mucosal resection were not favored, and the tumor was curatively removed via distal gastrectomy. The histopathologic diagnosis was papillary adenocarcinoma, and the invasion depth was the mucosal layer without vascular invasion, which was different from the preoperative diagnosis. Our case suggests the difficulties in precise diagnosis of the invasion depth of the giant polypoid cancer.
一名66岁的日本男性因疑似十二指肠癌被转诊至我院。上消化道内镜检查发现一个巨大的息肉样肿瘤，从十二指肠球部延伸至幽门环。计算机断层扫描显示一个略增强的小叶状肿瘤突入十二指肠球部。正电子发射断层扫描显示从胃窦到十二指肠球部区域有（18）F-氟脱氧葡萄糖聚集。由于内镜超声检查提示肿瘤可能侵犯肌层，不适合进行内镜黏膜切除术，遂通过远端胃切除术将肿瘤根治性切除。组织病理学诊断为乳头状腺癌，浸润深度为黏膜层，无血管侵犯，这与术前诊断不同。我们的病例提示了准确诊断巨大息肉样癌浸润深度的困难。
