Early Duodenal Adenocarcinoma Arising in Gastric Metaplasia Treated by Endoscopic Resection

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

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