Primary adenocarcinoma of the duodenum. Case report

Introduction: Duodenal adenocarcinoma is a rare neoplasm. Tumors of the small intestine account only for 1–5% of the neoplasms of the digestive tract. 20% OF the cases appear in n the duodenum. Histopathologically the most frequent type, 30–50% of the cases is adenocarcinoma. The incidence of carcinoid is 25–30%, lymphoma 10–20%, leiomyosarcoma 13–15%. Early clinical symptoms of these malignancies are typically vague and non-specific and for this reason the disease is often diagnosed at an advanced stage.

Case: A 64 year-old male patient presented with upper abdominal pain, vomiting and weight loss. He underwent gastroscopy which revealed complete duodenal obstruction caused by a tumor of 3cm extent, localized in the back wall of the second part of the duodenum. Biopsy has been performed. His laboratory tests did not show any pathological. The next diagnostic test was abdominal sonography, which also revealed a 3cm size formation in the duodenum. Computer tomography confirmed the diagnosis, did not verified metastases in the liver, but showed some pathological lymphoglandes in the retroperitoneum. We decided to perform surgical intervention. The operative finding was an annular tumor causing obstruction in the second part of the duodenum. The tumor was potentially resecable, therfore radical operation was the solution. The technique performed was hemipancreato-duodenectomy, pancreato-gastrostomy, cholecystectomy, choledocho-jejunostomy, gastric resection, gastro-ejunostomy and greater omentectomy. Histology proved adenocarcinoma involving the choledochus, Vater papilla, expanding into the interstitial tissue of the pancreas and infiltrating the lymphoglands of the greater omentum. These findings correlated with results of the endoscopic biopsy.

Conclusion: Malignant neoplasms of the small intestine are infrequent. In this case despite the advanced disease localization of the tumor made it possible to get a diagnosis soon after the manifestation of the symptoms. Radical surgical treatment was performed, because radio- and chemotherapy do not significantly improve survival. The patient is alive and in good health. He has only recently been operated, so long-term survival is still not assessable.