A resected case of duodenal cancer arising in Brunner's glands

A 77-year-old man was found to have a duodenal tumor by duodenoscopy. A biopsy specimen was histo-pathologically diagnosed as adenocarcinoma. Hypotonic duodenography showed that this tumor was located in the second portion of the duodenum, and was very close to the papilla duodeni. Preoperative endoscopic ultrasonography revealed that the tumor had deeply invaded the muscularis propria. We decided to resect the tumor with a minimal operation because the patient was elderly and he had multiple organ dysfunction. We performed distal gastrectomy with partial duodenectomy. We separated the duodenal second portion from the pancreatic head widely, and resected the tumor while preserving the papilla duodeni. Histopathological examination showed that this tumor arose from Brunner's glands of the duodenal lamina propria. According to the Japanese Classification of Gastric Carcinoma the case was: pTis pNO HO PO CYO MO lyO vO pPM (-) pDM (-), pStage 1 A. Duodenal carcinoma of Brunner's glands is very rare. We report this case and review previously reported cases in the literature.