Abstract
An 80-year-old man referred to our hospital for investigation of melena was pointed out having iron-deficiency anemia in his blood test. Upper gastrointestinal endoscopy showed a protruding tumor with ulceration in the first part of the duodenum. The preoperative histopathological diagnosis was neuroendocrine cell carcinoma (NEC) of the duodenal bulb. The anal margin of this lesion was adjacent to the papilla of Vater, thus, we performed subtotal stomach preserving pancreaticoduodenectomy. In the histopathological examination, large neoplastic cells which had a high N/C ratio and solid formation were observed. Immunohistochemically, the tumor cells revealed positive expression to synaptophysin and chromogranin A. Histopathologically, the tumor was large-cell NEC of the duodenal bulb with pancreatic invasion and lymph node metastasis (No. 13). The final diagnosis was pT3 (pancreas) N1M0 pStage III B of duodenal NEC. The patient has been alive as of 1 year 4 months after the operation without adjuvant chemotherapies. We report this case with some consideration from the relevant literature because NEC derived from the duodenal bulb is very rare.
