A 6.5-mm Carcinoid Tumor of the Duodenum with Lymph Node Metastases

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 75; no. 10; pp. 2763 - 2768
• Main Authors: KODAMA, Sota, KAN, Takatsugu, ADACHI, Yasushi, HOSOGI, Hisahiro, TSUBONO, Michihiko, KII, Eiji
• Format: Journal Article
• Language: Japanese
• Published: Japan Surgical Association 2014
• Subjects: carcinoid tumor of the duodenum; lymph node metastasis; neuro endocrine tumor
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.75.2763

Duodenal carcinoid tumors measuring less than 10 mm in diameter are generally considered to be associated with a low frequency of lymph node and distant metastases. Herein, we report the case of a 68-year-old man with a macroscopic carcinoid tumor measuring 8 mm in diameter at the duodenal bulb, with lymph node metastases. Preoperative abdominal CT revealed an 8-mm intrapyloric lymph node, although FDG-PET did not show accumulation in either the main tumor or in the lymph node. Distal gastrectomy with lymph node dissection (D1+) was performed, because two intrapyloric lymph nodes (2/3) detected intraoperatively were diagnosed by histopathology as metastases. However, since lymph node #13 (posterior surface of the pancreatic head) was diagnosed as being negative for metastasis, highly invasive surgery, e.g., pancreaticoduodenectomy, was avoided. The tumor was diagnosed by histopathology as NET G1 (carcinoid tumor) ; the Ki-67 (MIB-1) index of the main tumor was grade 1 (1.81% ; 44/2430), and the mitosis index was grade 1 (below 5/50 HPF). At present, one year since the surgery, the patient remains alive without recurrence. Thus, lymph node dissection should be carefully considered even in patients with tumors measuring less than 10 mm in diameter.