Abstract
An 82-year-old woman with common bile duct (CBD) dilatation observed during routine ultrasonography was referred to our hospital. Preliminary blood tests revealed elevated levels of hepatobiliary enzymes. Computed tomography (CT) scan showed lower bile duct wall thickening and enhancement. Esophagogastroduodenoscopy revealed mildly swollen papilla of Vater, without ulceration. Endoscopic retrograde cholangiography demonstrated that the CBD was grossly dilated with a constriction in the lower part. The final diagnosis indicated poorly differentiated adenocarcinoma of duodenal papilla with signet-ring cells; pT3N0M0, stage IIA (Unio Internationalis Contra Cancrum, 7th edition), for which subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) was performed. This case is quite rare, and the surgery resulted in a desirable outcome. The patient has been disease-free for 5 years since the surgery.
Highlights
Most duodenal papillary carcinomas (DPCs) are well differentiated [1]
Signet-ring cells in the duodenal papilla are an indication of poor prognosis
We report a case of poorly differentiated DPC with signet-ring cells that had favorable outcome
Summary
Most duodenal papillary carcinomas (DPCs) are well differentiated [1]. Poorly differentiated DPCs are rare and have unfavorable prognosis. We report a case of poorly differentiated DPC with signet-ring cells that had favorable outcome. Case presentation An 82-year-old woman with common bile duct (CBD) dilatation, as observed during routine ultrasonography, was referred to our hospital. The final diagnosis was poorly differentiated adenocarcinoma with signet-ring cell of DPC. The Japanese Society of Hepato-Biliary-Pancreatic Surgery reported that the most common histological type of DPC is welldifferentiated adenocarcinoma (36.3%), followed by papillary adenocarcinoma (27.6%) and moderately differentiated adenocarcinoma (25.0%). The proportion of signet-ring cells to whole carcinoma was about 10–15%, so we diagnosed poorly differentiated adenocarcinoma with signet-ring cells, and not SRCC.
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