Early Gastric Cancer Widespread Invading the Duodenum: A Case Report

Abstract

Background: Gastric cancer has been observed to infrequently infiltrate the duodenum, with a prevalence of duodenal involvement ranging from 11.9%-23.8% [1] among patients with cancer in the gastric antrum. However, it is importantto note that the majority of these instances pertain to advanced gastric cancers, as the occurrence of duodenal invasion in early gastric cancer is exceedingly uncommon. Case presentation: A 62-year-old female patient presented with peripyloric thickening of the gastric antrum near the pyloric ring on gastroscopy. The lesion extended into the duodenum, appearing as a nodular and uneven intraduodenal lesion near the pyloric ring. The majority of the lesion exhibited a type 0-IIa flat elevation covered by White Opaque Substance (WOS). A CT scan with enhanced examination revealed no evidence of enlarged metastatic lymph nodes or distant metastasis. Biopsy of the intragastric lesion indicated high-grade intraepithelial neoplasia, with no surrounding enlarged metastatic lymph nodes observed. The lesion exhibited softness during the endoscopic insufflation test, indicating its conformity with Early Gastric Cancer (EGC) characterized by the encircling invasion of the duodenum. A laparoscopic-assisted major gastrectomy (D2) procedure was conducted, accompanied by B-II anastomosis. The surgical intervention and subsequent recuperation proceeded without complications, and there was no evidence of metastatic recurrence within a 13-month postoperative period. Conclusion: This case presents an unusual instance of early gastric cancer, providing additional evidence to support the notion that early gastric cancer can indeed infiltrate the duodenum by directly penetrating the mucosal layer.