Primary duodenal adenocarcinoma is a rare malignant neoplasm accounting for 0.3% of all gastrointestinal tract carcinomas. We herein present one case of duodenal adenocarcinoma after duodenal neuroendocrine carcinoma. Poorly differentiated duodenal neuroendocrine carcinoma with liver metastasis (TxNxM1) was confirmed, and eight cycles of palliative chemotherapy (5-fluorouracil/etoposide/cisplatin) were administered. The patient was then in a clinically complete response status. About 1 year later, newly developed adenocarcinoma was detected at the same site. It was completely surgically resected, and the patient was cured.
Adenocarcinoma/*diagnosis/drug therapy ; Antineoplastic Agents/therapeutic use ; Duodenal Neoplasms/*diagnosis/drug therapy ; Humans ; Male ; Middle Aged ; Neoplasms, Second Primary/*diagnosis/drug therapy ; Neuroendocrine Tumors/*diagnosis/drug therapy

INTRODUCTIONBladder cancer is a common malignancy but presentation with metastatic disease is rare. This is the fi rst reported case of duodenal obstruction as a presentation of metastatic bladder cancer.

CLINICAL PICTUREA middle-aged woman presented with nausea, vomiting, weight loss and intermittent haematuria. Radiology and histology confirmed metastatic bladder cancer to the retroperitoneum encasing the duodenum and causing obstruction.

TREATMENTInsertion of a duodenal stent relieved the obstruction and palliative chemoradiotherapy was initiated.

OUTCOMEThe patient died 15 months after diagnosis.

CONCLUSIONSClinicians and radiologists should be aware of atypical presentations of common malignancies.

Adult ; Carcinoma, Transitional Cell ; drug therapy ; secondary ; Diagnosis, Differential ; Duodenal Obstruction ; diagnosis ; etiology ; surgery ; Fatal Outcome ; Female ; Humans ; Palliative Care ; Retroperitoneal Neoplasms ; complications ; diagnosis ; secondary ; Stents ; Urinary Bladder Neoplasms ; drug therapy ; pathology

OBJECTIVETo investigate the clinicopathological features, surgical treatment and prognosis of primary carcinoma of the duodenum.

METHODSThe clinicopathological data of 86 patients with primary duodenal carcinoma from January 1996 to June 2007 were retrospectively reviewed and analyzed by SPSS 13.0.

RESULTSThe clinical manifestation includes upper abdominal pain, jaundice, anemia, gastrointestinal obstruction, melena and weight loss. Four patients had a tumor located in the first portion of the duodenum, 66 in the second portion, 12 in the third portion and 4 in the fourth portion. The preoperative correct diagnostic rate by BUS was 41.7%, by CT 69.4%, by MRI 75.0%, by duodenal endoscopy 84.0%, and by air barium double radiography 80.9%. Complete resection of the tumors was achieved in 38 patients, palliative resection in 45 cases, and exploration alone in 3 cases. The median survival time of the group with complete resection was 42 months versus 13 months in the group with palliative resection, with a significant difference between the two groups (P < 0.05).

CONCLUSIONPrimary carcinoma of the duodenum has no specific symptoms. Early diagnosis and complete resection are effective to improve prognosis.

Adult ; Aged ; Chemotherapy, Adjuvant ; Duodenal Neoplasms ; diagnosis ; drug therapy ; pathology ; surgery ; Duodenum ; pathology ; surgery ; Female ; Follow-Up Studies ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Survival Rate