2020 Volume 53 Issue 4 Pages 321-328
A 39-year-old woman was referred to our hospital due to anemia. An upper gastrointestinal endoscopy revealed a type 2 tumor at the posterior wall of the duodenal bulb, while adenocarcinoma was diagnosed histopathologically. Enhanced CT showed no evidence of distant metastasis. The patient underwent pancreatoduodenectomy with curative intent. Histological findings revealed adenocarcinoma with enteroblastic differentiation in most areas of the resected specimen. Immunohistochemical findings were positive for alpha-fetoprotein. Neuroendocrine differentiation was observed in approximately 5% of the tumor. Although the tumor was macroscopically localized mainly in the duodenal bulb, the patient was given a diagnosis of gastric cancer with duodenal invasion because moderately differentiated tubular adenocarcinoma was found in the gastric mucosa of the pyloric region. Heterotopic gastric glands and ectopic pancreas were detected at the submucosa and muscle layer of the pyloric region. The patient is currently alive and without recurrence at 20 months after surgery.
