Abstract
A 67-year-old man without any symptoms was admitted to our hospital for further investigation after an abnormality of the duodenal bulb was pointed out elsewhere. Hypotonic duodenogram showed a polypoid lesion in the duodenal bulb, and endoscopic examination disclosed that it was whitish, nodular and pedunculated. Although the histological diagnosis of biopsy (specimen) was adenoma, carcinoma was strongly suspected by both of x-ray and endoscopic examination. Therefore, endoscopic biopsy using a snarewire was performed to differentiate adenoma from carcinoma. The large biopsy specimens obtained by this method revealed papillotubular adenocarcinoma. Gastrectomy, partial duodenectomy and lymph node dissection were performed. A nodular, pedunculated tumor with broad base, 2.8 × 1.9 cm in diameter and 1.2 cm in height, was found in the duodenal bulb. Histological examination of the resected specimen proved papillotubular adenocar-cinoma partially invading the muscularis mucosae. In this case, the big snare biopsy was very useful for the diagnosis of the duodenal polypoid lesion.
