Primary adenocarcinoma of the fourth portion of the duodenum: "A case report and literature review"

Abstract

Introduction: Primary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy.

Presentation of case: A 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later.

Discussion: Primary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum.

Conclusion: This report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.

Fig. 1

Upper gastrointestinal endoscopy showing a Type 2 tumor around the circumference with stenosis at distal portion of the papilla of Vater. Endoscopic biopsy specimen showing a well-differentiated tubular adenocarcinoma of the duodenum.

Fig. 2

The duodenogram showing a Type 2 tumor of the 4th portion of the duodenum.

Fig. 3

Abdominal computed tomography scan showing an irregularly thick wall of the 4th portion of the duodenum. No lymph nodes were found around the pancreas, superior mesenteric artery, or the aorta.

Fig. 4

(A) The resected specimen showing a Type 2 tumor at the 4th portion of the duodenum, measuring 50 mm × 45 mm in size. (B) Histological findings of the resected specimen showing a well-differentiated tubular adenocarcinoma (Hemotoxylin Eosin stain, magnification 20×). (C) Histological findings of the resected specimen showing a well-differentiated tubular adenocarcinoma (Hemotoxylin Eosin stain, magnification 100×).