A Small Type Ⅱa+Ⅱc Early Cancer Mimicking Advanced Cancer of the Duodenal Bulb Associated with a Mucus-Secreting Polyp, Report of a Case Kin-ichi Yokota 1 , Yusuke Saito 1 , Shuji Okuyama 1 , Masamitsu Yuki 1 , Masayoshi Namiki 1 1The Third Department of Internal Medicine Asahikawa Medical College Keyword: 十二指腸球部癌 , pm癌 , 粘液分泌型ポリープ , PCNA pp.697-702
Published Date 1993/6/25
DOI https://doi.org/10.11477/mf.1403106195
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 A 69-year-old man was admitted to our hospital for a further evaluation of a duodenal cancer. Screening x-ray examination for stomach cancer revealed antral deformity. More detailed upper gastrointestinal x-ray and endoscopic examination showed a small type Ⅱa+Ⅱc like lesion and a hemispherical polyp on the anterior wall of the duodenal bulb. The latter polyp secreted mucus from an orifice. The biopsy specimen from the former lesion disclosed a well-differentiated adenocarcinoma. Resected specimen showed an irregularly depressed lesion with marginal elevation, measuring 10×10 mm in size, and a hemispherical polyp, measuring 6×6 mm in size, in the duodenal bulb. Histologically the former was a papillary adenocarcinoma invading the muscular layer, and the latter was consistent with a mucus-secretingpolyp, type Ⅰ being reported by Tanaka et al. Epithelium of this polyp was invaginated into the submucosal layer from an orifice, resulting in the formation of a lumen, whose wall was composed of gastric type foveolar epithelium and Brunner's glands. There was proliferating cell nuclear antigen along the boundary between gastric type villi and Brunner's glands. In the bottom of the polyp proliferating cells formed a line just above the muscular layer. Papillary adenocarcinoma of our case did not have brush border and goblet formation, which suggested gastric differentiation. Malignant transformation seemed to arise from the proliferating zone of mucus-secreting polyps and invade the muscular layer easily. Small advanced cancer, less than 10 mm in size, of the duodenum is rare in the literature.

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