DUODENAL ADENOCARCINOMA: A CASE REPORT

Objective: Cancers of the small intestine are rare pathologies. They occur with vague and unspecific symptoms and cause many problems in differential diagnosis. Methods: A 64-years-old man, smoker, suffered inappetence, nausea and vomit over about 20 days until the presence of melena led to his admission to our hospital. His history included diabetes mellitus and moderate alcohol intake. The objective examination showed a hard-inelastic swelling in epi-mesogastric region. Laboratory data showed an increase of leukocytes and elevated level of CA 19-9. Esophagogastroduodenoscopy showed a duodenal vegetans neoformation, subjected to examination biopsy and bacterial culture. Computed tomography scans showed a voluminous duodenal mass without safe plans of cleavage with the head of the pancreas. The biopsy results were not decisive for the presence of necrotic tissue. The microbiological culture was positive for Candida Glabrata mimicking an advanced mycotic abscess. Laparotomy revealed a palpable hard mass in duodenum. Cephalic duodenopancreatectomy was performed. Results: Postoperative period was regular. The patient resume eating during the sixth postoperative day and was discharged in good conditions. The final histological diagnosis was papillary moderately differentiated adenocarcinoma with expansive growth in duodenal wall. There was no lymph node involvement or distant organ metastasis. Conclusions: The duodenal tumors are rare pathologies. There is association with familial adenomatous polyposis, Cronh disease, alcohol abuse, smoking, peptic ulcer. Diagnosis is based on endoscopic and imaging techniques. The main prognostic factors are tumor stage, lymph node involvement and metastasis. When is possible we perform a radical approach reserving palliative treatment for advanced neoplasm.