2023 Volume 65 Issue 12 Pages 2407-2412
In August 2018, a man in his 80s was referred to our hospital for upper gastrointestinal endoscopy, which revealed a 6-mm, slightly depressed lesion in the lower part of the duodenal bulb. Biopsy showed signet-ring cell carcinoma in the intrinsic layer of the mucosa. Initially, we planned to resect the lesion endoscopically due to the absence of obvious metastasis on contrast-enhanced computed tomography. However, by the time of the treatment in November 2018, the lesion had rapidly increased in volume and presented as a thick depressed lesion with marginal elevation. The lesion was resected en bloc endoscopically. Histologically, it was diagnosed as poorly differentiated adenocarcinoma with signet ring cell carcinoma, featuring a submucosal invasion depth of greater than 1000μm, positive deep tumor margin, and positive lymphatic invasion. Additional surgery including pancreaticoduodenectomy was recommended, but the patient declined and eventually succumbed to cancer in October 2019.
The occurrence of undifferentiated duodenal adenocarcinoma with a gastric phenotype at an early stage is rare. Furthermore, no case reports have documented early-stage duodenal adenocarcinoma showing a rapid progression within a short period. Our case was rare and holds value in understanding the progression of early-stage duodenal adenocarcinoma.
