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More than meets the eye: Duodenal metastasis of cervical squamous carcinoma

  • Shi-Ze Xiong
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
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  • Lu Chen
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
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  • Wei Liu
    Correspondence
    Correspondence author: Dr. Wei Liu, gastroenterology, China Three Gorges University, 88 heyi road, Yichang, Hubei 443000, China
    Affiliations
    The First College of Clinical Medical Science, China Three Gorges University, Yichang, China

    Institute of Digestive Disease, China Three Gorges University, Yichang, China

    Department of Gastroenterology, Yichang Central People's Hospital, Yichang, China
    Search for articles by this author
Published:September 26, 2022DOI:https://doi.org/10.1016/j.amjms.2022.09.018
      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 (Figure 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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