2017 Volume 59 Issue 1 Pages 41-47
A 49-year-old man who underwent esophagogastroduodenoscopy （EGD） owing to positive fecal occult blood test results, had a 0-Ⅰs＋Ⅱc-like lesion of 15 mm in diameter in the duodenum. During the preoperative EGD, the lesion was found to be elastic and soft on palpation with a forceps and was visualized as an abnormal area with various echo levels including anechoic areas in the 2nd to 3rd layers on endoscopic ultrasonography （EUS）. The surface pattern was clearly visible on NBI magnification endoscopy. We first considered that the lesion was a duodenal cancer with massive submucosal invasion based on its macroscopic shape. However, findings of the preoperative EGD suggested that the lesion could be mucosal cancer or an adenoma. Therefore, we performed endoscopic mucosal resection （EMR） to determine malignancy and invasion depth of the tumor. Histology showed a high-grade adenoma with Brunner’s gland hyperplasia. The macroscopic shape of 0-Ⅰs＋Ⅱc was due to inverted growth and cystic expansion of the tumor glands. The findings of this case suggest that minimally invasive treatment should be pursued using every endoscopic modality in the case of a duodenal lesion that is suspected of being a submucosal cancer.
