A RESECTED CASE OF RECURRENT MINUTE CARCINOID OF THE DUODENUM AFTER OPERATION

Abstract

This paper report a case of recurrent minute carcinoid of the duodenum after operation in a 44-year-old woman. The patient had undergone a partial resction of the duodenum for minute carcinoid (5mm in size, sm) in the descending part of the duodenum in 1993, and then was followed up in the outpatient clinic. In January, 1997, she was found having a Yamada's type 2 tumor about 1cm oral from the duodenal papilla. With a biopsy, carcinoid was diagnosed. The patient was admitted to the hospital for operation with a diagnosis of recurrence of duodenal carcinoid. At operation, an ill-defined indulation about 2cm in size infiltrating into the pancreatic head was seen, and a pancreatico duodenectomy was performed. In general, carcinoids of the duodenum which are less than 20mm in size and submucosal or shallower in tumor invasion are indicated local resection. In our case, however, despite the primary duodenal tumor was 5mm in size with the depth of tumor invasion of sm which fulfilled the conditions, the recurrece had occurred after operation, that was thought very rare. We decide that local resection can be indicated for minute carcinoids, but preoperative close examination of the depth of tumor invasion, intraoperative exploration of lymph nodes, and postoperative clinical observation may be important.