Abstract
A 47-year-old female was admitted with complaints of nausea, general malaise and icterus. On endoscopic examination, a protruding lesion like submucosal tumor with irregular ulcer and bleeding at the ulcer base was noted at the papilla of Vater. The biopsy specimens taken from the margin of the ulcer showed group V (adenocarcinoma). Under the diagnosis of carcinoma of the papilla of Vater, pancreatoduodenectomy was performed. On resected specimens, the tumor was 2.5 ×2.0 × 0.6 cm in size, and showed nodular development from submucosa to proper muscle layer of the duodenum. Histologically, the tumor was composed of two lesions. The one was well differentiat-ed adenocarcinoma located in the surface of tumor, and the other predominantly consisted of solid nest-like proliferation of tumor cells with round or oval nuclei. In the later cells, argyrophil reaction stained by Grimelius method showed positive, and electromicroscopic finding demonstrated the neurosecretory granules in the cytoplasm. The tumor was diagnosed as carcinoid. It was considered that two different malignant lesions existed at the same region in this case.
