Abstract
Multiple carcinoid tumor in the duodenal bulb was found by upper GI endoscopy performed as an annual check up of 53 years old male. His serum gastirn level was elevated to 702pg/ml. CT scan revealed no metastasis of carcinoid tumor nor lymph node swellings. The tumor was sized 7mm and 5mm, both were located in mucosa and submucosa of the duodenal bulb by EUS examination. Endoscopical mucosal resection (EMR) was performed and the tumor was completely removed. Serum gastrin level went down to 123pg/ml after the EMR. Immunohistochemical examinations of the tumor by anti-gastirnantibody and chromogranin A were both positive. 7 months after the EMR, left renal cell carcinoma was found by CT scan examination and left nephrectomy was performed. Only 6 cases of multiple duodenal carcinoid tumor were reported in recent 25 years in Japan, 3 cases with hypergastrinemia. By the pathological observation of the tumor biopsy specimen as well as the size of tumors, we chose EMR to treat this case. But It is important to keep up the close examinations to detect the recurrence however the tumor was thought to have low grade of malignancy. It is also important to check up the existence of malignant tumor of other organs when you find duodenal carcinoid tumor.
