Zusammenfassung
Duodenale Frühkarzinome sind eine Seltenheit. Die meisten duodenalen Karzinome werden
in einem fortgeschrittenen Stadium diagnostiziert. Wir berichten den Fall einer 59-jährigen
Patientin, welche zur weiteren Diagnostik und Therapie eines auswärts diagnostizierten
duodenalen Frühkarzinoms zu uns überwiesen wurde. Die Ösophagogastroduodenoskopie
bei Aufnahme ergab eine Typ IIa+c-Läsion im proximalen Duodenum (10 - 12 mm große
zentral diskret eingesenkte Läsion). Mittels Chromo- und Magnifikationsendoskopie
konnte die Läsion gut demarkiert und Veränderungen der Zottenarchitektur im Sinne
einer Neoplasie gesehen werden. Nach Unterspritzung mit einer verdünnten Adrenalin-Lösung
konnte die Läsion komplikationslos endoskopisch reseziert werden. Die Histologie ergab
ein Adeno-Frühkarzinom vom gastralen Typ, entstanden in einer inkompletten gastralen
Metaplasie. Zusammenfassend handelt es sich um die Fallvorstellung eines duodenalen
Frükarzinoms, welches in einer inkompletten gastralen Metaplasie entstanden ist und
erfolgreich endoskopisch reseziert wurde.
Abstract
Early duodenal carcinoma is a rare entity. Most duodenal carcinomas are diagnosed
at a more advanced stage. This report describes the case of a 59-year-old lady with
an early duodenal adenocarcinoma diagnosed at check-up gastroduodenoscopy in an outpatient
clinic who was referred to us for further investigation and management. The initial
upper endoscopy at our department revealed a type IIa+c lesion in the proximal duodenum
(10 - 12 mm diameter, flat elevated lesion with central depression). Using chromoendoscopy
and magnification endoscopy the lesion could be well demarcated and neoplastic changes
in the architecture of the intestinal villi could be detected. After submucosal epinephrine-saline
injection, the lesion was removed by endoscopic resection without complications. Histopathological
examination revealed the rare entity of an early duodenal carcinoma arising from incomplete-type
gastric metaplasia in the duodenum. In summary, the presented paper describes a case
of successful endoscopic treatment of an early duodenal carcinoma arising from incomplete
gastric metaplasia.
Schlüsselwörter
Duodenale Frühkarzinome - duodenale Neoplasie - Adenokarzinom - endoskopische Resektion
- gastrale Metaplasie - Pylorusadenom
Key words
Early duodenal carcinoma - duodenal neoplasm - adenocarcinoma - endoscopic resection
- gastric metaplasia - pyloric gland adenoma
References
1
Dabaja B S, Suki D, Pro B. et al .
Adenocarcinoma of the small bowel: presenting, prognostic factors, and outcome of
217 patients.
Cancer.
2004;
101
518-526
2
Sohn T A, Lillemoe K D, Cameron J L. et al .
Adenocarcinoma of the duodenum: factors influencing long-term survival.
J Gastrointest Surg.
1998;
2
70-87
3
Nagatani K, Baba Y. et al .
Indications for endoscopic treatment of early duodenal cancer: based on cases reported
in the literature.
Endosc Digest.
1993;
7
969-976
4
Schmidt C M, Powell E S, Yiannoutsos C T. et al .
Pancreaticoduodenectomy: a 20-year experience in 516 patients.
Arch Surg.
2004;
139
718-725
5
Hirasawa R, Iishi H, Tatsuta M. et al .
Clinicopathological features and endoscopic resection of duodenal adenocarcinoma and
adenomas with the submucosal saline injection technique.
Gastrointest Endosc.
1997;
46
507-513
6
Oka S, Tanaka S, Nagata S. et al .
Clinicopathologic features and endoscopic resection of early primary non-ampullary
duodenal carcinoma.
J Clin Gastroenterol.
2003;
37
381-386
7
Voutilainen M, Juhola M, Farkkila M. et al .
Gastric metaplasia and chronic inflammation at the duodenal mucosa.
Dig Liver Dis.
2003;
35
94-98
8
Wyatt J I, Rathbone B J, Sobala G M. et al .
Gastric epithelium in the duodenum: its association with Helicobacter pylori and inflammation.
J Clin Pathol.
1990;
43
981-986
9
De Vita O, Bondi A, Euse-Bi V. et al .
Simultaneous polypoid tumors of the stomach and duodenum with composite cell population
(mucous, argyrophil, and lysozyme-containing cells): a case report.
Am J Gastroenterol.
1984;
79
606-610
10
Kushima R, Rüthlein H J, Stolte M. et al .
Pyloric gland-type adenoma’ arising in heterotopic gastric mucosa of the duodenum,
with dysplastic progression of the gastric type.
Virchows Arch.
1999;
435
452-457
11
Kushima R, Stolte M, Dirks K. et al .
Gastric-type adenocarcinoma of the duodenal second portion histogenetically associated
with hyperplasia and gastric- foveolar metaplasia of Brunner’s glands.
Virchows Arch.
2002;
440
655-659
12
Russin V, Krevsky B, Caroline D F. et al .
Mixed hyperplastic and adenomatous polyp arising from ectopic gastric mucosa of the
duodenum.
Arch Pathol Lab Med.
1986;
110
556-558
13
Shimizu N, Tanaka S, Morikawa J. et al .
Early duodenal cancer of the bulb: report of a case [in Japanese].
Gan No Rinsho.
1989;
35
100-106
14
Shousha S, Parkins R A.
Multicentric early adenocarcinoma involving stomach and duodenum.
Arch Pathol Lab Med.
1987;
111
875-876
15
Vieth M, Kushima R, Kushima R. et al .
Pyloric gland adenoma: a clinico-pathological analysis of 90 cases.
Virchows Arch.
2003;
442
317-321
16
Ahmad N A, Kochman M L, Long W B. et al .
Efficacy, safety, and clinical outcomes of endoscopic mucosal resection: a study of
101 cases.
Gastrointestinal Endoscopy.
2002;
55
390-396
17
Pech O, May A, Gossner L. et al .
Management of pre-malignant and malignant lesions by endoscopic resection.
Best Pract Res Clin Gastroenterol.
2004;
18
61-76
18
Rembacken B J, Gotoda T, Fujii T. et al .
Endoscopic mucosal resection.
Endoscopy.
2001;
33
709-718
19
Giovannini M, Bernardini D, Moutardier V. et al .
Endoscopic mucosal resection (EMR): results and prognostic factors in 21 patients.
Endoscopy.
1999;
31
698-701
20
Vogt M, Jakobs R, Benz C. et al .
Endoscopic therapy of adenomas of the papilla of Vater: a retrospective analysis with
long-term follow-up.
Digest Liver Dis.
2000;
32
339-345
21
Kume K, Okubo Y, Ejiri Y. et al .
Early duodenal carcinoma successfully treated by endoscopic mucosal resection.
Dig Endosc.
2000;
12
177-180
22
Nishida K, Nojiri I, Kato M. et al .
A case of early duodenal cancer resected by endoscopic polypectomy in the elderly
[in Japanese].
Nippon Ronen Igakkai Zasshi.
1993;
30
705-708
23
Obata S, Suenaga M, Araki K. et al .
Use of strip biopsy in a case of early duodenal cancer.
Endoscopy.
1992;
24
232-234
24
Sakaida I, Yoshida T, Okita K.
Edoscopic resection of early duodenal cancer using a strip biopsy technique.
Am J Gastroenterol.
2000;
95
1600-1601
25
Sanomura M, Tanaka S, Ito M. et al .
Depressed-type, early duodenal carcinoma (carcinoma in situ) treated by endoscopic
mucosal resection.
J Gastroenterol.
2003;
38
813-815
26
Tringali M, Crotta S, Bodrato C. et al .
Early primary duodenal carcinoma successfully treated by endoscopic polypectomy.
Endoscopy.
1994;
26
709
27
Miyata M, Yokoyama Y, Okoyama N. et al .
What are the appropriate indications for endoscopic mucosal resection for early gastric
cancer? Analysis of 256 endoscopically resected lesions.
Endoscopy.
2000;
32
773-778
28
Seto Y, Shimoyama S, Kitayama J. et al .
Lymph node metastasis and preoperative diagnosis of depth of invasion in early gastric
cancer.
Gastric Cancer.
2001;
4
34-38
29
Ono H, Kondo H, Gotoda T. et al .
Endoscopic mucosal resection for treatment of early gastric cancer.
Gut.
2001;
48
225-229
Prof. Dr. C. Ell
Department of Medicine II, HSK Wiesbaden
Ludwig-Erhard Strasse 100
65199 Wiesbaden
Germany
Phone: ++ 49/6 11/43 24 20
Fax: ++ 49/6 11/43 24 18
Email: ell.hsk-wiesbaden@arcor.de