A Resected Case of Primary Adenocarcinoma of the Fourth Portion of the Duodenum with Multiple Lung and Lymph Node Metastases

Abstract

A 70-year-old man was admitted to our hospital due to severe anemia. Upper gastrointestinal endoscopy showed a type 2 tumor at the distal part of the duodenum. Computed tomography demonstrated an enhanced mass at the fourth portion of the duodenum, with enlarged adjacent lymph nodes and multiple small nodules in bilateral lung fields. He developed hypovolemic shock because of tumor bleeding, and emergent surgery was performed. The duodenum was segmentally resected with the periduodenal lymph nodes. Histological findings showed well to moderately differentiated adenocarcinoma invading into the sub-serosa and positive lymph nodes. He recovered successfully, and chemotherapy with S-1/oxaliplatin + bevacizumab was continued sequentially. The number and size of multiple lung and lymph node metastases were almost stable, and he survived more than one year after surgery.