The patient is a 67-year-old male. At a periodic medical examination, a polypoid lesion was discovered in the duodenal bulb by endoscopy. A biopsy of the reddish tinged apex lesion was performed and diagnosed to be a carcinoid tumor. Invasion of the submucosa was confirmed under endoscopic ultrasound. An operation was performed through a laparotomy incision to pertially resected to duodenal bulb area, accompanied by lymph node sampling. Two carcinoid tumors were resected, one was 10mm by 9mm, and the other was 1 mm by 1 mm.
The literature supports practice guidelines of performing endoscopic mucosal resection (EMR) on tumors measuring 1 cm or less. However, in some EMR cases there have been incidences of insufficient tumor margines, which have resulted in lymph node metastasis.
In this case, in order to decrease the risk of lymph node metastasis, an open laparotomy with radical resection of the tumor and lymph node sampling was performed. We conclude that this procedure is appropriate from a curative and quality of life standpoint.
