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A Case of Non-ampullary Duodenal Endocrine Cell Carcinoma(NEC) Presenting IIa+IIc Like Lesions Ryosuke Kiyomori 1,2 , Koichi Kurahara 1 , Yumi Oshiro 3 , Koji Ikegami 1 , Takehiro Torisu 2 , Kazuhito Minami 4 , Norihito Nakano 5 1Division of Gastroenterology, Matsuyama Red-cross Hospital, Matsuyama, Japan 2Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan 3Department of Pathology, Matsuyama Red-cross Hospital, Matsuyama, Japan 4Department of Surgery, Matsuyama Red-cross Hospital, Matsuyama, Japan 5Department of Gastroenterology, Yawatahama City General Hospital, Yawatahama, Japan Keyword: 十二指腸 , 非乳頭部 , 内分泌細胞癌 , NEC , 胃型形質 pp.766-776
Published Date 2024/5/25
DOI https://doi.org/10.11477/mf.1403203631
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 A male patient in his 80s underwent upper gastrointestinal endoscopy and was found to have duodenal lesions. He was diagnosed with adenocarcinoma based on a biopsy and was referred to our department for further examination. Hypotonic duodenography revealed an IIa+IIc like lesion <15mm in diameter in the contralateral papillary area of the descending segment. Lateral view of the lesions indicated an arch-shaped deformity. Upper gastrointestinal endoscopy revealed thick lesions and poor extension when air was fed. The areas surrounding the lesions presented submucosal tumor-like elevations without epithelial alterations. Although slough was present at the lesion's depressed base, narrow band imaging and magnified endoscopy indicated orientation-related microvascular anomalies and the disappearance of villus architecture in the margins of the elevated site around the lesion's depressions, suggesting tumor exposure. Suspected of SM-massive cancer, subtotal stomach-preserving pancreaticoduodenectomy was performed. The resected specimen presented findings of endocrine cell carcinoma with an adenocarcinoma component in the elevated area around the lesions, infiltrating into the submucosal layer of the lesions and a slight infiltration into the muscular layer of the central depressed area. Consequently, the patient was diagnosed with neuroendocrine carcinoma, large cell type(neuroendocrine cell carcinoma 80%, adenocarcinoma 20%), pT2N1M0(WHO classification, 5th ed.). According to the cancer classification in Japan, it is classified as endocrine cell carcinoma.Moreover, based on the result of an immunohistochemical examination performed on a concomitant adenocarcinoma, the patient was considered to have endocrine cell carcinoma arising from adenocarcinoma of Brunner's gland(MUC6 positive).


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

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