title: Primary adenocarcinoma of the fourth portion of the duodenum: "A case report and literature review".
abstract: BACKGROUND
  Primary adenocarcinoma of the 4th portion of the duodenum is reported less frequently than those other portions of the duodenum. Therefore, few reports discuss the diagnosis and treatment of this malignancy.
  
  
  METHODS
  A 54-year-old woman was admitted to our hospital with a complaint of nausea and vomiting after a meal. Upper gastrointestinal examination and a duodenogram revealed a Type 2 tumor of the 4th portion of the duodenum, which was diagnosed as well-differentiated tubular adenocarcinoma by endoscopic biopsy. Partial resection of the duodenum and jejunum was performed on the basis of intraoperative evaluation of negative lymph node metastasis around the pancreas and proximal duodenum with no macroscopic invasion toward the pancreas and proximal duodenal margin. Her postoperative course was uneventful without any sign of recurrence 5 years later.
  
  
  CONCLUSIONS
  Primary adenocarcinoma in the 4th portion is relatively less common. It is not easy to diagnose this disease. Patients with primary duodenal adenocaricinoma, who are medically fit to undergo surgery, should be given the option of aggressive resection. Duodeno-cephalo-pancreatectomy remains the standard treatment for adenocarcinomas of the 1st and 2nd portion of the duodenum. Partial resection is the preferred surgical method for patients with adenocarcinoma of the 3rd and 4th portions of the duodenum.
  
  
  CONCLUSIONS
  This report describes a rare case of primary adenocarcinoma of the 4th portion of the duodenum, successfully treated by partial resection of the duodenum and jejunum. However, larger studies are required to clarify the indications for the preferred surgical method for this malignancy.
authors.affiliation: Division of Advanced Surgical Science and Technology, Tohoku University School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8574, Japan. Electronic address: torun@med.tohoku.ac.jp.
authors.forename: Toru
authors.initials: T
authors.lastname: Nakano
authors.forename: Koh
authors.initials: K
authors.lastname: Sugawara
authors.forename: Kenji
authors.initials: K
authors.lastname: Hirau
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Hirano
authors.forename: Masaji
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Tsuneo
authors.initials: T
authors.lastname: Kaiho
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi