Duodenal Adenocarcinoma With Suspected Brain Metastasis

Abstract

Duodenal adenocarcinoma (DA) is a rare tumor. We present the case of an 84-year-old lady who presented with episodic emesis with progressive dysphagia to solids and liquids. She also noted a significant weight loss of 31kg over four months. She was reported to have multiple brain masses three months before this admission. A computed tomography (CT) scan showed a heterogeneous mass (8cm) in the left retroperitoneum, inseparable from the duodenum. Additional peritoneal nodules and enlarged retroperitoneal lymph nodes were suspicious for metastases. Esophagogastroduodenoscopy revealed extrinsic compression of the stomach by the tumor. A large friable distal duodenal mass (fourth part) partially obstructed the lumen, which was biopsied. Pathology results demonstrated high-grade dysplasia but did not confirm malignancy. The patient's carcinoembryonic antigen (CEA) was elevated, but cancer antigens (CA)125 and CA19-9 were normal. A percutaneous biopsy of the mass revealed enteric-type adenocarcinoma. Immunohistochemistry showed that the tumor was positive for caudal-type homeobox (CDX)2, negative for special AT-rich sequence-binding protein (SATB)2, and patchy positive for cytokeratin (CK)7 and CK20 staining. The collective evidence suggested a duodenal primary. The patient opted for hospice and died in three days. We lack pathological evidence, but the patient's brain masses were suspicious of metastases. This would be one of the few reported cases of DA with possible brain metastases.

A Rare Case of Duodenal Adenocarcinoma With Brain Metastasis

“…One case report reported a brain mass and biopsy-proven duodenal primary in an 84-year-old female patient. In that report, brain mass was not biopsy-proven as the patient opted for a palliative approach due to her elderly age [17]. Another case report reported the de novo presentation of jejunal adenocarcinoma with brain metastasis [15].…”

Uranium Translocation From Water Soil and Rock System to Various Plants and Their Components

“…The accumulation of uranium has a signi cant impact on the germination, early growth of seedlings, photosynthesis, and metabolic and physiological functions of plants. [5]Geochemical processes, absorption and movement inside plants, harmful effects on plants, entry into the food chain, and ultimately, in uence on human well-being. Furthermore, alterations in the physico-chemical characteristics of soil and groundwater resulting from land use practices and shifts in climatic conditions after few decades also impact the presence of uranium in the terrestrial environment.[6-8].…”

Clinicopathological Characteristics, Treatment and Prognosis in Duodenal Adenocarcinoma with Liver Metastasis: A SEER-Based Study

“…This is partly due to the fact that some advanced patients reject the above treatment options for palliative care. 19 Surgical resection is currently the only treatment for DAC with curative potential. Ryder et al showed that the 5-year OS rate was 43% in DAC patients with tumor resection and only 13% in patients without tumor resection.…”