Primary small-cell neuroendocrine carcinoma of the duodenum - a case report and review of literature.
BACKGROUND
Small-cell neuroendocrine carcinoma in the duodenum is an extremely rare neoplasm with poor prognosis.


METHODS
A 57-year-old man presented with sudden onset gastrointestinal bleeding and fainting attacks. Duodenoscopy and hypotonic duodenography revealed a 3 x 3 cm protruding tumor with ulcerations situated opposite the ampulla of Vater in the second part of the duodenum. Local excision of the tumor was performed, followed by adjuvant chemotherapy with 5-fluoro uracil and leucovorin. Examination of the tumor by immunohistochemistry and electron microscopy indicated it to be neuroendocrine in nature, expressing synaptophysin and AE1/AE3, and containing dense core granules. The patient showed no sign of recurrence and has been disease-free for more than 48 months after surgery.


CONCLUSIONS
Most cases of small-cell neuroendocrine carcinoma in the duodenum show rapid progression of the disease, and even radical surgery with or without chemotherapy do not prevent death. We report a rare subtype of small-cell neuroendocrine carcinoma. This subtype appears to have a much better prognosis, and may be amenable to local excision, if the lesion is away from the ampulla of Vater.
Sata
Naohiro
N
Department of Surgery, Jichi Medical School, 3311-1 Yakushiji Minami-kawachi Tochigi, Japan. sata@jichi.ac.jp
Tsukahara
Munetoshi
M
Koizumi
Masaru
M
Yoshizawa
Koji
K
Kurihara
Katsumi
K
Nagai
Hideo
H
Someya
Tsutomu
T
Saito
Ken
K