予後不良であった十二指腸乳頭部カルチノイドの1例

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  • A CASE OF CARCINOID OF THE DUODENAL PAPILLA WITH A POOR PROGNOSIS

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We encountered a patient with carcinoid of the duodenal papilla, which grew from a tumor in the pancreatic duct and presented with obstructive jaundice. This carcinoid should have been diagnosed as endocrine cell carcinoma with a poor prognosis. The patient was a 50-year-old man. He was admitted to the hospital because of fever and jaundice. After jaundice reduction, pancreatoduodenectomy was carried out. A papillary tumor 1.5cm in diameter, and another papillary lesion 2cm in diameter in the pancreatic duct were found. Regional lymph node metastases were observed. The lesion showed histological findings of solid and partially trabecular formation, submucosal growth, and severe lymphatic invasion. Nucleoli were circular, and karyotype was markedly irregular. The cytoplasm was scarce, and many granules were observed. The tumor was weakly positive for somatostatin staining. The patient recovered and was discharged from the hospital on the 40th postoperative day, but he underwent transcatheter arterial embolization (TAE) for liver metastases 4 months postoperatively. The patient died of cancer 2.5 months after TAE. The autopsy findings included liver, retroperitoneal lymph node and peritoneal metastases. It is considered that carcinoids of the duodenal papilla often recur, have a poor prognosis, and require wide-ranging dissection for surgery.

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