Abstract
We report a case of a 64-year-old woman who presented with abdominal pain and a palpable tumor in the right abdomen. Blood analysis revealed an increased level of CEA, and endoscopic examination detected a Type 2 mucinous adenocarcinoma of the duodenal descending limb opposite from the hepatopancreatic ampulla of Vater. CT showed a 10 cm right abdominal cavitary tumor perforating into the duodenum and ascending colon, invading the transverse colon with lymph node metastasis, and possibly invading the inferior vena cava. The tumor was considered unresectable and S-1 chemotherapy was initiated. Initial chemotherapy generated a reduction in the level of CEA by half. Abscess formation in the tumor cavity induced severe fever and anemia, making it impossible to continue S-1 chemotherapy. Pancreatoduodenectomy and right hemicolectomy were performed. Tumor pathology showed duodenal mucinous adenocarcinoma with invasion to the colon and metastasis to one lymph node next to the inferior vena cava. Adjuvant S-1 chemotherapy was continued postoperatively and there were no signs of recurrence at 18 months postoperatively. Thirteen Japanese cases of primary duodenal mucinous adenocarcinoma that included chemotherapy were analyzed, and the present case may provide a therapeutic strategy for similar cases in the future.
