Tumours of the Duodenum
Case PresentationAli Chami PGYIV28/7/2015
22 year old female patient presented for a 3 months history of
abdominal discomfort, generalized fatigue, weight loss, and
anorexia. Pain is described as epigastric in origin, dull,
radiating to back, and related to meals. No fever, chills, nausea,
vomiting, diarrhea, constipation or dysuria.
PMH: NonePSH: Open appendectomyAllergies: NoneMeds: NoneOther:
Non-smoker, non-alcoholicTreated by many physicians conservatively
PPI, spasmolytics, and iron supplements with no improvement of
symptoms.
One week prior to presentation to our institution patient
started to develop yellowish discoloration of her skin and
eyesWeight loss 10 kg in one month.Clay color stool, and tea
colored urine.
TestResultWBC3200RBC2.25Hct17.5Hb5.3MCV78Plt372000Neutrophils22%Lymphocytes55%Monocytes5%Eosinophils18%Basophils0%TestResultSGOT182SGPT229GGT301Alk.
Phos992Bil T/D 7.3/5.7Total protein 6.2Albumin3.6EGD
BiopsyPrimary duodenal poorly differentiated adenocarcinoma CT
ScanCT Scan chest ,abdomen, and pelvisD2 circumferential tumor
5cmCBD dilatation at 9 mmDilatation of duct of Wirsung 11 mmCeliac
lymphadenopathy 12mmLeft ovarian cyst 34mmMinimal peritoneal
fluidNormal chestPET CT
Physical ExamTemp: 37.2 HR: 116 RR 18 BP 100/6042 kgAbdominal
examination: Soft, non-distended, minimal epigastric tenderness, no
palpable masses or herniaROS: Normal
TestResultHb10.7Hct33.6WBC11.4Neu72%Lymph12%Plt588MCV82INR1.14TestResultBilirubin
T/D18/15Albumin 3.46Amylase184Lipase1492Alk. Phos 1080GGT
441SGOT/SGPT198/234CA 19-9 NrmlCEA NrmlORPancreaticoduodenectomyEn
bloc lymphadenectomy11 celiac LN9 porta hepatis LN3 hepatic LNDuct
to mucosal anastamosis
PathologyAdenocarcinoma of small bowel moderately to poorly
differentiatedFree marginsRegional LN: 1/18Celiac, hepatic and
porta hepatis LN: No infiltration
Post-Op CourseNo major complicationsNo evidence of leakReferred
to further GI screening upon full recoveryPrimary Duodenal
AdenocarcinomaOutlineIntroduction-Epidemiology-Risk
Factors-Associated syndromesPathogenesis and morphologyComparison
to other peri-ampullary tumorsPresentationDiagnosisPrognostic
indicatorsTreatment-Early duodenal AC
treatment-Resectability-SurgeryAdjuvant and neoadjuvant
therapyPalliative proceduresConclusionIntroductionArises from
Lieberkuhn epithelium of duodenal mucosa0.05% of all
malignancies
