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A Borderline Lesion between Malignancy and Benignity Located in the Papillary Region of the Duodenum K. Fukumoto 1 , K. Katake 1 , F. Misaki 2 13 rd. Dept. of Internal Med., Kyoto Red Cross Hospital 23 rd. Dept of Internal Med., Kyoto Prefectural University of Medicine pp.1504-1506
Published Date 1972/11/25
DOI https://doi.org/10.11477/mf.1403109043
  • Abstract
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 The patient : U. M., a 72-year-old man.

 In August 1970 he was admitted to an emergency hospital because he had a bout of colic in the abdomen. He underwent surgical intervention there under a diagnosis of choledocholithiasis. However, even after the operation the fever persisted ranging from 38°to 39℃, so that he was referred to our hospital.

 At admission, he was slightly anemic with the stool positive for occult blood. Slight increase was noted in the SGOT, SGPT and alkaline phosphatase. X-ray examination of the upper digestive tract (Figs. 1 and 2) showed a tumor-like shadow at a site corresponding to the papillary region. Percutaneous transhepatic cholangiography (Fig. 3) disclosed swollen papillar region with dilated common bile duct. The distal end of the duct appeared rigid and narrowed, and in the adjacent papilla was an irregular flow of contrast medium visualized. Endoscopic pictures (Figs. 4 and 5) revealed the papillar region having on the mucosal surface a number of tiny white flecks and a reddened nodular lesion. The papillary region was greatly swollen as a whole. Biopsy was tried with little sucoess because the lever in the forceps was out of order and we were unable to obtain specimens from the tissue initially aimed at. It was impossible then to diagnose this case accurrately, but great importance was attached to the findings of the nodule, and, fortified by those of the x-ray, we tentatively diagnosed it as cancer in the papillary region.

 The patient underwent re-operation in January of the following year. During the operation the aforementioned nodule was resected, its frozen section (Fig. 6) revealing stratified arrangement of cells and irregular polarity of the glandular structure. Histological diagnosis was made as Grop Ⅲ. Pancreatoduodenectomy was accordingly performed. Figure 7 shows its fresh specimed, and Figure 8 represents histological picture of a longitudinal section of the papillary region. Edema and cellular infiltration are manifest, but its atypicaliry is slighter as compared with the frozen section. Only a diagnosis of papillitis could be made.

 The present case seems to exemplify a borderline lesion between malignancy and benignity because diagnosis by both x-ray and endoscopy was cancer of the papillary region and histologically the nodular lesion was confirmed as Group Ⅲ and the other parts as Group Ⅱ.


Copyright © 1972, Igaku-Shoin Ltd. All rights reserved.

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電子版ISSN 1882-1219 印刷版ISSN 0536-2180 医学書院

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