Early Duodenal Cancer Supposedly Arising from the Brunner's Gland, Report of a Case Tadahisa Miyamoto 1 , Shuzo Matsuba 1 , Yoshifumi Yokoyama 1 , Muneaki Sugimura 2 , Masae Tatematsu 4 1The First Derartment of Internal Medicine, Nagoya City University Medical School 2Sugimura Clinic 4Ultrastructure Research Laboratory, Aichi Cancer Center Research Institute Keyword: 十二指腸癌 , 早期癌 , 粘液組織化学 , 免疫組織化学 , Brunner腺 pp.1395-1399
Published Date 1991/12/25
DOI https://doi.org/10.11477/mf.1403102719
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 A 45-year-old woman was admitted to our hospital for a further examination of a duodenal lesion noted at Sugimura clinic. Barium x-ray and endoscopy revealed a flat polypoid lesion with nodular and slightly reddish surface, most of which was located in the anterior wall of the duodenal bulb growing toward the lesser curvature. This lesion was thus thought to be early cancer limited at most to the submucosal layer of the duodenum. The lesion was histologically adenocarcinoma on biopsy specimens.

 Examination of the material resected by partial duodenogastrectomy showed that the lesion, 19×14 mm in size, was histologically well differentiated tubular adenocarcinoma invading into the mucosal layer without metastasis to the adjacent lymphnodes. Mucin histochemistry and pepsinogen (Pg) immunohistochemistry were employed to define phenotypic expression of duodenal cancer cells, demonstrating intracellular mucin of class Ⅲ because it was stained positively by paradoxical concanavalin A, but not by the galactose oxidase-Schiff and sialidase-galactose oxidase-Schiff staining; cytosolic Pg was stained positively by anti-Pg Ⅱ, but not by anti-Pg Ⅰ, antibody. Furthermore, there was no pyloric gland metaplasia in the duodenal mucosa surrounding the lesion on histologic specimens obtained from the duodenum resected. These findings strongly suggested that this duodenal cancer arose primanriy from the Brunner's gland. Early duodenal cancer implicating its cellular origin has been very rarely reported up to date.

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