Duodenal lymphangitis carcinomatosa: endoscopic characteristics and clinical significance.
OBJECTIVE
Duodenal lymphangitis carcinomatosa has been sporadically described, but so far little attention has been paid to duodenal lymphangitis carcinomatosa.


METHODS
Four cases with duodenal lymphangitis carcinomatosa were endoscopically and histologically examined.


RESULTS
The four cases exhibited multiple polypoid lesions along the Kerckring's folds and/or were covered by characteristically granular, non-ulcerated mucosa upon thickening. The granularity seems to been caused by dilated lymph vessels containing the carcinoma cells. The lesions were microscopically characterized by: (i) involvement of lymph vessels located in the upper portion of the lamina propria; (ii) no inflammatory changes; and (iii) no desmoplastic changes. Primary sites were thought to be the stomach in case 1, the pancreas in cases 2 and 4, and unknown in case 3. All patients died within 6 months after admission or endoscopic examination.


CONCLUSIONS
As duodenal lymphangitis carcinomatosis shows characteristic endoscopic appearance, endoscopic diagnosis is not difficult. We should realize that the lesion represents extremely poor prognosis, and it should be distinguished from ordinary metastatic duodenal carcinoma.
Nakasono
Masahiko
M
Department of Pathology, University of Tokushima Schoool of Medicine, Tokushima, Japan. mnakasono@ybb.ne.jp
Hirokawa
Mitsuyoshi
M
Muguruma
Naoki
N
Okamura
Seisuke
S
Ito
Susumu
S
Okazaki
Michiyo
M
Horie
Takahiro
T
Kimura
Masuo
M
Takeuchi
Mayuko
M
Inoshita
Toshi
T
Sano
Toshiaki
T
D000368:Aged; D002277:Carcinoma / Q000473:pathology* / Q000556:secondary; D003937:Diagnosis, Differential; D004379:Duodenal Neoplasms / Q000473:pathology* / Q000556:secondary; D004384:Duodenoscopy; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology; D008205:Lymphangitis / Q000473:pathology*; D042601:Lymphatic Vessels / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000473:pathology*; D013274:Stomach Neoplasms / Q000473:pathology*