A Duodenal Cancer Arising from Brunner Gland Adenoma Resected by Laparoscopic Distal Gastrectomy

Abstract

A 71-year-old woman was found to have a large duodenal tumor on screening by abdominal PET-CT. Esophagogastro-duodenoscopy revealed a large semipedunculated tumor in the duodenal bulb and biopsy specimens were histologically diagnosed as Brunner’s gland adenoma. In diagnostic imaging, the tumor was at least 5 cm in diameter and the precise location of the tumor stalk extending to duodenum could not be determined. Suspecting benign tumor based on endoscopic biopsy, we decided to remove the tumor to avoid duodenal obstruction due to tumor growth and the potential of malignancy. Because of endoscopic findings, we considered endoscopic polypectomy to be risky and performed laparoscopic distal gastrectomy with partial duodenectomy using intraoperative laparoscopic ultrasonography (LUS) under the water soakage method to accomplish total laparoscopic resection. Histopathological examination showed that this tumor was 50 mm in diameter and diagnosed as Brunner gland adenoma with adenocarcinoma. To the best of our knowledge, this is the first report of a case of duodenal carcinoma of a huge Brunner gland tumor resected laparoscopically determining the distal margin of duodenum by intraoperative LUS using the water soakage method.