Hepatoid adenocarcinoma (HAC) is a rare extrahepatic tumor distinguished by having both hepatoid and adenomatous features, which can make the diagnosis challenging. Although it mostly originates in the stomach, several other sites of origin have been reported. We report a case of HAC originating in the duodenum, a very unusual location. We also discuss an approach to the diagnosis of HAC using morphological and immunohistochemical features, and explore possible therapeutic options.

Injuries caused by grill brush bristle ingestion have been documented in the literature, but most existing literature focuses on consumer safety and increasing public awareness of potential injuries. Small bowel perforation is a serious complication and often difficult to diagnose since symptoms are frequently nonspecific and bristle localization can be challenging. We highlight a case where a diagnosis of acute pancreatitis was initially made by computerized tomography (CT) imaging but was later determined to be small bowel perforation with magnetic resonance imaging (MRI). 1 Due to its high resolution and excellent anatomic depiction of different pathologies, including inflammation and tumors, MRI is often used as an imaging modality when the cause of pancreatitis is not clear through initial history, physical exam, or imaging modalities like ultrasound and CT scan. MRI provides an opportunity to detect pathologies that cannot be depicted by CT because of its high contrast resolution (though conversely, CT has a higher spatial resolution, so there are some cases in which it can detect things that MRI cannot). This case highlights the importance of considering MRI to diagnose and evaluate complications in suspected cases of wire bristle ingestion prior to endoscopic or surgical extraction.

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