1993 Volume 43 Pages 174-177
A 64-year-old man was referred to our hospital, because an elevated lesion at the duodenal bulb was pointed out in upper GI X-ray series by his doctor. In the initial endoscopy in our hospital, only small part of elevated lesion was just noted through the pylorus and biopsy from the lesion revealed well-defferentiated tubular adenocarcinoma.
Subtotal gastrectomy was performed. In the removed specimen, early carcinoma (typeI+IIa) , 22×8 mm in size, was located on the pyloric ring, but not in the bulb. Although according to the general rules for the gastric cancer study in Japan, a border between stomach and duodenum is defined to be a pyloric ring (edge of the thickest pyloric sphincter) , it was also hard to decide from where the carcinoma was derived, as the carcinoma was located on a pyloric ring. Taking the possibility of deviation by the fixation into consideration, it should be appropriate to make a border between them by the marginal line which Brunnner's gland was appeared. Finally, we diagnosed the carcinoma located mainly in the stomach.
We reported a case which suggested that a border between stomach and duodenum should be decided microscopically.
