Murakami Masatoshi, Fujimori Nao, Noguchi Shoko, Yamamoto Takeo, Matsumoto Kazuhide, Ueda Keijiro, Ikenaga Naoki, Aishima Shinichi, Nakamura Masafumi, Ogawa Yoshihiro
Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-Ku, Fukuoka, 812-8582, Japan.
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
Clin J Gastroenterol. 2025 Jun 7. doi: 10.1007/s12328-025-02157-4.
A 73-year-old man presented with liver dysfunction secondary to a distal bile duct stenosis. Initially, an ampullary neoplasm was suspected. Cytological and histological examinations were repeated, but no definite malignant cells were detected. The bile duct stricture improved with temporary metal stent placement. However, 21 months after the initial visit, stenosis of the second part of the duodenum was observed. Despite the absence of malignant cells, pancreaticoduodenectomy was performed due to strong suspicion of cancerous stenosis. Post-operative pathological findings revealed primary advanced duodenal carcinoma (pT4, pN1, cM0, and pStage IIIA), with the tumor extensively involving the submucosal tissue of the duodenum and extending to the muscular to the serosal layers. Invasion into the bile duct, pancreas, and ampulla or peri-ampullary duodenum was observed, but tumor cells were scattered within normal mucosa, complicating preoperative diagnosis. He received capecitabine/oxaliplatin as adjuvant chemotherapy for 6 months, and 14 months postoperatively, no recurrence was observed.This is an extremely rare case of duodenal carcinoma extending into the submucosal tissue, with no previous reports of such an extension. Bile duct strictures can be challenging to differentiate between benign and malignant causes, and duodenal carcinoma should be considered as a contributing factor.
一名73岁男性因远端胆管狭窄继发肝功能障碍就诊。最初怀疑为壶腹肿瘤。多次进行细胞学和组织学检查，但未检测到明确的恶性细胞。通过临时放置金属支架，胆管狭窄有所改善。然而，初次就诊21个月后，观察到十二指肠第二部狭窄。尽管未发现恶性细胞，但由于高度怀疑癌性狭窄，仍进行了胰十二指肠切除术。术后病理结果显示为原发性晚期十二指肠癌（pT4、pN1、cM0，p分期IIIA期），肿瘤广泛累及十二指肠黏膜下组织，并延伸至肌层至浆膜层。观察到肿瘤侵犯胆管、胰腺、壶腹或壶腹周围十二指肠，但肿瘤细胞散在于正常黏膜内，使术前诊断复杂化。他接受了6个月的卡培他滨/奥沙利铂辅助化疗，术后14个月未观察到复发。这是一例极为罕见的十二指肠癌延伸至黏膜下组织的病例，此前尚无此类延伸的报道。胆管狭窄在鉴别良恶性病因方面可能具有挑战性，十二指肠癌应被视为一个促成因素。
