1986 Volume 28 Issue 7 Pages 1610-1618_1
A 52 years-old man with no abdominal complaints was recommended further precise examination of the duodenum after upper GI series. Roentgenographic examination of the upper GI tract revealed a polypoid lesion more than 30 mm in diameter at the first portion of the duodenum. Endoscopic examination showed a smooth elevated lesion like IIa+IIc without erosion or bleeding. The biopsy specimens showed papillary adeno-carcinoma. Pancreato-duodenectomy and lymph node dissection were performed. Surgical specimens showed a smooth elevated IIa +IIc like lesion, measuring 35 × 30 mm in diameter at the duodenal bulb to the second portion. Histological examination of the resected specimens showed papillary adenocarcinoma located within mucosa and submucosa without lymph node metastasis. Case reports of primary early cancer of the duodenum are rare. The authors collected 31 cases of primary early carcinoma of the duodenum in Japanese literature (1968-1984) excluding the cancer at the area of papilla Vater. As far as the characteristics of the tumor surface, gross appearance, and histology were concerned, the early duodenal cancer reported in Japan was rather similar to the early colon cancer comparing to the early gastric cancer. The 14 cases (40.6%) were asymptomatic, and were detected by mass survey. The pre-operative biopsy diagnosis showed group III in 10 cases. If the diagnosis of the biopsy specimen of duodenal tumor reveals group II or III, careful treatment is necessary. It is appropriate that a definition of early duodenal cancer implies mucosal and submucosal cancer of duodenum, because the prognosis of cancers defined as this is good, and metastases are rarely found. Histo-pathological studies show the two types of duodenal cancer : one is "cancer in adenoma", the other is "de novo cancer". It is not yet conclusive if the duodenal cancer arises from the adenoma or from the mucosa of the duodenum itself.
