Abstract
A 71-year-old man visited a medical clinic complaining of vomiting, and was referred to our hospital for examination. Blood examination showed leukocytosis (white blood cell count 17,480 /μl) and his serum CA19-9, DUPAN-2, and Span-1 levels were elevated (2,804, 841, and 134 U/ml, respectively). Abdominal computed tomography revealed a heterogeneously enhanced tumor with a diameter of about 6 cm in the third portion of the duodenum. Upper gastrointestinal endoscopy revealed a submucosal tumor at the same location. The endoscopic biopsies showed duodenitis (group 1). From these findings, a diagnosis of duodenal tumor was made and partial resection of the duodenum and jejunum was performed. On macroscopic observation, the duodenal tumor had ulcerated, forming an extramural mass 6 cm in diameter. Histologically, there were areas of adenocarcinoma forming tumor glands and areas of squamous cell carcinoma with keratinization. The histological examination confirmed the diagnosis of adenosquamous carcinoma of the small intestine. The patient underwent postoperative chemotherapy. However, he died 10 months postoperatively, after local recurrence was found in the 8th postoperative month and liver metastases were found in the 9th postoperative month. Adenosquamous carcinoma of the small intestine is rare; including this case, there have been only 26 cases reported in the Japanese literature.
