A case of groove pancreatic cancer detected by duodenal findings during esophagogastroduodenoscopy

An 80-year-old man was diagnosed with groove pancreatic cancer based on duodenal findings of a routine esophagogastroduodenoscopy (EGD). The EGD showed slight narrowing of the duodenum at the superior duodenal angle suggestive of invasion of other organs by the carcinoma. Endoscopic ultrasonography (EUS) showed a 21 × 10 mm hypoechoic tumor with indistinct boundaries in the groove region. A histopathologic diagnosis of adenocarcinoma was made by EUS-guided fine-needle aspiration, and a subtotal stomach-preserving pancreaticoduodenectomy was performed. A pathological examination revealed that the tumor had invaded from the outer wall to the duodenal muscularis layer. This could have been recognized during EGD as slight narrowing of the superior duodenal angle. Since EGD may enable the detection of asymptomatic pancreatic cancer, careful endoscopic manipulation is required during duodenal examinations.