An early superficial non-ampullary duodenal tumor cured with endoscopic submucosal dissection: A case report

Abstract

Early superficial non-ampullary duodenal tumors are particularly rare, the clinical manifestations, including typical endoscopic or imaging features, and treatment methods are not well-characterized. The present case report describes a case of an asymptomatic 74-year-old male who presented to the Taizhou People's Hospital (Taizhou, China) for a regular health screening, where a primary superficial non-ampullary duodenal tumor was identified. Upper endoscopy revealed ~1.2 cm lesion in the second portion of the duodenum. Chromoscopy and magnification endoscopy indicated an early cancer characteristic. Subsequent endoscopic submucosal dissection was performed to remove the lesion. Histopathology validated that the lesion was a high-grade intro-epithelial neoplasm without lymph node or blood vessel invasion.

Keywords: endoscopic submucosal dissection; high grade intro-epithelial neoplasm; magnifying endoscopy; narrow band imaging; superficial non-ampullary duodenal tumor.

Figure 1.

An early superficial non-ampullary duodenal tumor. (A) A flat elevated lesion (1.2 cm) was visible in the second portion of the duodenum, using conventional endoscopy with white light imaging. (B) Surface pattern was preserved in one region and is absent in another region, and an unclassified vascular pattern was exhibited following magnifying endoscopy with narrow band imaging. (C) The endoscopic submucosal dissection method was performed to cure the lesion. (D) The whole lesion was cut from duodenum. (E) The lesion was diagnosed as a category 4/5 tumor by hematoxylin and eosin staining (magnification, ×100).