Abstract
An 81-year-old man underwent colonoscopy for a positive fecal occult blood test at a medical checkup. The patient was then referred to our hospital for surgical resection of a 30-mm tumor of the ascending colon detected by the colonoscopy. A biopsy showed the tumor to be high-grade dysplasia or extremely well differentiated adenocarcinoma. Preoperative screening with esophagogastroduodenoscopy unexpectedly revealed a tumor in the fourth portion of the duodenum. The lesion was diagnosed by biopsy as well-differentiated tubular adenocarcinoma.
We consulted several high-volume endoscopic centers regarding the possibility of endoscopic treatment of the duodenal tumor, but none of them recommended endoscopic therapy because of the location and the suspected invasion depth of the tumor into the submucosal structure. Hence, we performed segmental resection of the duodenum together with ileocecal resection under laparotomy. Early carcinoma of the fourth portion of the duodenum is extremely rare and the early detection by screening is difficult. We report here a rare case of early primary cancer of the fourth portion of the duodenum that was detected by screening esophagogastroduodenoscopy, along with a review of the relevant literature.
