Abstract
A 78-year-old man was found to have a 2-cm mass at the 1.2cm oral side of the papilla of Vater in upper gastrointestinal endoscopy. A biopsy specimen was diagnosed as a moderately differentiated adenocarcinoma. He showed no endocrinological nor gastrointestinal symptoms clinically except for glucose intolerance. The Serum somatostatin was elevated to 140pg/ml （normal: 1.0-12） preoperatively. Under a diagnosis of duodenal cancer, we conducted pylorus-preserving pancreaticoduodenectomy. The tumor invade the head of the pancreas. No metastasis to the liver, but the surrounding lymph nodes of the pancreatic head contained metastasis. The tumor cells were arranged in trabecular and glandular structures, but psammoma body was not observed. The tumor lacked mitotic activity. Immunohistochemically, the tumor was intensely positive for somatostatin, and positive for chromogranin, but negative for insulin, gastrin, pancreatic polypeptide, serotonin, and glucagons. The patient remains alive without recurrence 16 months after the surgery.
