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Abdomen » Gastrointestinal
Primary Adenocarcinoma of the Duodenum
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Presentation A 78-year-old woman was admitted to the hospital because of persistent vomiting and weight loss, abdominal distension, iron-deficiency anemia, and intermittent epigastric pain.
Caption: Realtime scans upper abdomen
Description: Transverse and sagittal scanning of the mid upper abdomen reveals a hypoechoic mass of approximately 5 cm in the transverse segment of the duodenum with an echogenic center (pseudokidney sign) and dilated duodenal bulb and gastric lumen.
Differential Diagnosis Pancreatic adenocarcinoma
Periduodenal Lymph node metatstases
Annular pancreas

Final Diagnosis Primary Adenocarcinoma of the Duodenum
Discussion Primary tumors of the duodenum are uncommon . Benign tumours include
  • Adenoma,
  • Adenomatous polyp,
  • Lipoma
  • Leiomyoma

Malignant tumours include :
  • Adenocarcinoma
  • Leiomyosarcoma
  • Lymphoma
  • Carcinoid tumor

Adenocarcinoma is the most common primary malignant neoplasm of the duodenum, with 50%–70% of small bowel adenocarcinomas occurring either in the duodenum or proximal jejunum.

Primary adenocarcinoma of the duodenum is usually found in the periampullary region , therefore is extremely rare of the distal segment .

In patients with upper abdominal complaints, ultrasonography is widely used as the first
imaging procedure .

In this case report we describe the possibility that  ultrasonography can  be used for the diagnostic suspicion of a tumour in the distal segment of the duodenum , naturally the diagnosis must be confirmed with the most appropriate methods.

Case References
  1. EA Kazerooni, LE Quint and IR Francio ; Duodenal neoplasms: predictive value of CT for determining malignancy and tumor resectability; American Journal of Roentgenology, Vol 159, 303-309
  2. Spira IA, Ghazi A, Wolff WI. Primary adenocarcinoma of the duodenum. Cancer 1977 Apr;39(4):1721-6 UI:77159769
  3. Carragher A, Russell C. Carcinoma of the duodenum. Postgrad Med J 1987 Oct;63(744):907-8 UI:88189982
  4. R Zissin, ,A Osadchy,G Gayer, M Shapiro-Feinberg, ; Pictorial review :CT of duodenal pathology; The British Journal of Radiology, 75 (2002), 78–84
  5. Katsumichi Iki, Atsushi Nogami, Hideki Harada, Muneo Echigo, Takashi Kiyama, Tsukasa Tsunoda,  Toshifumi Eto; Primary adenocarcinoma of the duodenum demonstrated by ultrasonography ; J Gastroenterol 2001; 36:195–199

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