A CASE OF EARLY GASTRIC CANCINOMA PROLAPSING INTO THE DUODENUM WHICH PRESENTED DIFFICULTY IN DIFFERENTIAL DIAGNOSIS FROM PRIMARY DUODENAL TUMOR

Abstract

It is difficult to differentiate gastric tumors incarcerating into the duodenum without typical clinical features from primary duodenal tumors. An 87-year-old man visited a clinic because of general fatigue. He was reffered to the hospital with a diagnosis of gastric polyp and duodenal tumor on gastric endoscopy. Laboratory studies on admission revealed anemia and hypoproteinemia. Stools were positive for occult blood. A duodenal cancer was suspected on upper G.I. series, gastric endoscopy, hypotonic duodenography, abdominal CT scans and angiography. So an operation was performed. Intraoperatively, the duodenal tumor was able to restore manually into the stomach, and it was diagnosed as a pyloric tumor prolapsing into the duodenum. Distal gastrectomy with D0 lymph nodes dissection was then performed. On gross findings of the surgical specimen, the prolapsed tumor showed lobulated polypoid lesion located in pylorus and was diagnosed histopathologically as a carcinoma in adenoma and a well differentiated adenocarcinoma with invasion depth of m. The postoperative course was uneventful and the anemia and hypoproteinemia were improved. The patient was discharged from the hospital on 24 th day after the operation. Considering about the patients' age, the endoscopic polypectomy should be appropriate for the first treatment. In the case of duodenal tumors, it is important to suspect them of gastric tumors prolapsing into the duodenum and to repeat examinations for the differential diagnosis.