A 67-year-old woman with a 10-year history of cervical carcinoma treated with surgical
operation and external radiation therapy presented with abdominal pain, nausea, and
vomiting. On physical examination, the patient had epigastric tenderness. A contrast-enhanced
computed tomography scanning of the abdomen revealed a 20 cm-long asymmetric wall
thickening of both descending and horizontal parts of the duodenum with mural stratification
(Fig. 1A, B). Upper gastrointestinal endoscopy revealed merely swelling and diffuse mucosal
congestion along descending and horizontal portions of the duodenum instead of visible
duodenal masses (Fig. 1C). An initial biopsy was performed. Histology confirmed tumor cell infiltration of
the duodenal mucosa (Fig. 1D, hematoxylin-eosin stain). Immunohistochemical staining for cervical squamous carcinoma
markers demonstrated tumor cells diffusely positive for CK7 (Fig. 2A), CK5/6 (Fig. 2B), P40 (Fig. 2C), and P63 (Fig. 2D), thus diagnosing metastatic cervical cancer to the duodenum, which was further
defined by a high proliferation index Ki-67 around 90% in neoplastic cells (Fig. 2E). Targeted therapy combined with immunotherapy was started, but after initial clinical
response she developed hepatic, retroperitoneal and adrenal masses consistent with
metastases.
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References
- Acute gastrointestinal bleeding: a report of rare presentation of duodenal metastasis from cervical squamous cell carcinoma.Cureus. 2021; 13: e16245https://doi.org/10.7759/cureus.16245
- Duodenal metastasis of cervical adenosquamous carcinoma.Clin Gastroenterol Hepatol Off Clin Pract J Am Gastroenterol Assoc. 2012; 10: A34https://doi.org/10.1016/j.cgh.2012.02.020
- Metastatic cervical cancer to the duodenum: a learning point.Cureus. 2021; 13: e13874https://doi.org/10.7759/cureus.13874
Article info
Publication history
Published online: September 26, 2022
Accepted:
September 21,
2022
Received:
June 25,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.
