A case of small elevated early duodenal adenocarcinoma in the second portion of the duodenum successfully diagnosed by magnifying endoscopy with narrow-band imaging

Abstract

A 70-year-old female underwent esophagogastroduodeno scopy as part of a routine medical evaluation due to symptoms of epigastric discomfort, which thus revealed a small elevated lesion in the duodenum opposite the duodenal papilla. The diagnosis based on biopsy specimens was group 3, tubular adenoma. Conventional endoscopy using white-light revealed a whitish small elevated lesion. Magnifying endoscopy revealed an irregular villous structure with a white rim. Magnifying endoscopy with narrow-band imaging showed meandering irregular vessels demonstrating an unequal caliber in their villous structures. Because early duodenal cancer was suspected based on the endoscopic findings, an endoscopic mucosal dissection (ESD) was selected for both diagnostic and treatment purposes. The lesion was completely resected by ESD and was sutured by means of endoscopic clipping. The resected specimen measured 7×5×2 mm/11×8mm in size. A histopathological examination revealed well differentiated intra-mucosal adenocarcinoma without vascular invasion. Irregular ductal structures with vascular-rich, atypical nuclei were observed. The atypical nuclei showed positive staining for p-53 and MIB-1 immunohistochemistry. The lesion was complete resected and there were no complications.