Gastric-type Adenocarcinoma with Inverted Cystic Tubulovillous Adenoma of the Duodenum Observed by Magnifying Narrow Band Imaging, Report of a Case Michiko Nakaoka 1 , Makoto Eizuka 2 , Hideyuki Chiba 1 , Naoya Okada 1 , Jun Tachikawa 1 , Jun Arimoto 1 , Keiichi Ashikari 1,3 , Hiroki Kuwabara 1 , Toru Goto 1 , Atsuhiko Sakamoto 4 , Tamotsu Sugai 2 1Department of Gastroenterology, Omori Red Cross Hospital, Tokyo 2Division of Molecular Diagnostic Pathology, Department of Pathology, School of Medicine, Iwate Medical University, Morioka, Japan 3Department of Gastroenterology and Hepatology, Yokohama City University Hospital, Yokohama, Japan 4Department of Clinical Laboratory, Omori Red Cross Hospital, Tokyo Keyword: 十二指腸癌 , 胃型腫瘍 , 内反性発育 , Brunner腺 , 拡大内視鏡 pp.501-514
Published Date 2021/4/25
DOI https://doi.org/10.11477/mf.1403202309
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 A woman in her 70s was found to have an approximately 15-mm submucosal tumor-like pedunculated lesion on the superior duodenal angle, which was revealed by esophagogastroduodenoscopy. Three depressed sites were seen on the surface of the lesion, where magnifying narrow band imaging revealed characteristic areas with a regular villous and papillary microsurface pattern or regular microvessel construction and large intervening irregular microsurface pattern or microvessel construction. The lesion was finally diagnosed as carcinoma with adenoma and was subsequently treated by endoscopic mucosal resection. Histopathological findings revealed a moderate grade of atypia in the tubulovillous adenoma and a well-differentiated tubular adenocarcinoma. Moreover, the depressed areas had the characteristics of inverted growth. The lesion had a gastric phenotype, and the Brunner's gland and the ectopic gastric mucosa were found close to the lesion. Therefore, we confirmed the diagnosis as gastric-type adenocarcinoma with inverted cystic tubulovillous adenoma. The lesion was believed to have originated from the Brunner's gland, and intestinal metaplasia in the ectopic gastric mucosa, observed using magnifying narrow band imaging, was useful in the qualitative diagnosis.

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