A Cancer in Adenoma of the Stomach Prolapsing into the Duodenal Bulb, Report of a Case

Hirohumi Ishikawa, Akihiko Watanabe, Touru Okumura, Hidetomo Sawada, Katsunori Nakatani, Hiroshige Nakano, Hiroshi Maruyama*, Masahiro Tsutsumi*, Yoichi Konishi

The First Department of Surgery and *The Department of Oncological Pathology, Cancer Center, Nara Medical University

A 50 year-old man, who had been aware of general fatigue, nausea after meal and tarry stools for past two years, was admitted to our hospital for further examination of a polypoid lesion of stomach. Upper GI X-rays showed a large gastric pedicled tumor prolapsing into the duodenal bulbus. Endoscopy revealed two gastric pedicled tumors on the anterior and posterior wall of the antrum and the larger one, on the posterior wall, partially prolapsed into the duodenal bulbus. Biopsies of both tumors revealed histologically tubular adenoma with slight atypia of the nucleus. The stomach was surgically resected with lymph node cleanings under the diagnosis of a carcinoma in adenoma of the stomach prolapsing into the duodenal bulbus. The tumors on the posterior wall was 12.5×3×2.5 cm in size and on the anterior wall was 2.5×1.5×2.5 cm in size. Grossly, both tumors were pedicled with nodular surface. Histologically, each polypoid tumor was composed of several nodular masses with elevation of the muscular mucosa along an axis. Most nodular masses were diagnosed as adenoma (papillotubular type, colonic type), but some areas which revealed severe cellular and structural atypia with a clear border with the adenoma were diagnosed as well differentiated adenocarcinoma.

Key words
adenoma of the stomach, carcinoma in adenoma of the stomach, tumor prolapsing into the duodenal bulb

Reprint requests
Hirofumi Ishikawa The First Department of Surgery, Nara Medical University
840 Shijyo-cho, Kashihara, 634 JAPAN

Accepted
June 13, 1990

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