Iwata Kentaro, Kato Motohiko, Nakayama Atsushi, Kanai Takanori, Yahagi Naohisa
Department of Internal Medicine Division of Gastroenterology and Hepatology Keio University School of Medicine Tokyo Japan.
Division of Research and Development for Minimally Invasive Treatment Cancer Center Keio University School of Medicine Tokyo Japan.
DEN Open. 2022 Feb 26;2(1):e100. doi: 10.1002/deo2.100. eCollection 2022 Apr.
A 70-year-old female diagnosed with duodenal cancer was referred to our hospital. Esophagogastroduodenoscopy revealed an 80 mm flat elevated lesion was located in the inner wall of the second part of the duodenum and the lesion completely involved major papilla. Endoscopic submucosal dissection (ESD) was performed and the lesion was resected in a single piece including the part of the major papilla. The pathological examination of the resected specimen showed moderately differentiated adenocarcinoma limited in the mucosa in most parts of the lesion, however, cancer cells invaded into the submucosal layer with an invasion depth of 100 μm in only a small area. Lymph ductal involvement was confirmed in that area. Two months after ESD, pylorus-preserving pancreatoduodenectomy combined with extended lymph node dissection was additionally performed. The postoperative pathological examination revealed lymph ductal involvement was observed in the regional lymph node. While the postoperative clinical course was uneventful, systematic metastasis was pointed out 5 months after surgery. The patient was died 9 months after surgery. Due to its rarity, the natural history of duodenal cancer has been still unclear. In this case, even a lesion with only a localized small area of submucosal invasion developed systemic metastasis, indicating the high malignant potential of duodenal cancer.
一名70岁的女性被诊断为十二指肠癌，转诊至我院。食管胃十二指肠镜检查发现十二指肠第二部内壁有一个80毫米的扁平隆起病变，该病变完全累及主乳头。进行了内镜下黏膜下剥离术（ESD），将病变连同主乳头的一部分完整切除。切除标本的病理检查显示，病变大部分区域的黏膜内为中分化腺癌，但仅在一小区域癌细胞侵入黏膜下层，浸润深度为100微米。该区域证实有淋巴管受累。ESD术后两个月，额外进行了保留幽门的胰十二指肠切除术并扩大淋巴结清扫。术后病理检查显示区域淋巴结有淋巴管受累。术后临床过程平稳，但术后5个月发现有系统性转移。患者术后9个月死亡。由于十二指肠癌罕见，其自然病程仍不清楚。在本病例中，即使是仅在局部小区域有黏膜下浸润的病变也发生了系统性转移，提示十二指肠癌具有较高的恶性潜能。
