Radical resection for duodenal carcinoma with isolated bilateral ovarian metastasis: a case report
Keywords:Duodenal carcinoma, Ovarian metastasis, Whipple’s procedure
Natural history of duodenal adenocarcinoma is not well known. Although extremely rare, the incidence of primary small bowel adenocarcinoma has been increasing. Primary duodenal cancer is a very rare, which has accounted for only 0.3% of all gastrointestinal cancers. Isolated ovarian metastasis from duodenal carcinoma is extremely rare entity. We report a case of duodenal carcinoma with isolated bilateral ovarian metastasis in a 39-year-old female patient managed surgically with Whipple’s procedure with bilateral oophorectomy. She presented with complaints of dyspepsia and intermittent vomiting since 1½ years. History of anorexia and weight loss present. Upper gastrointestinal endoscopy was suggestive of circumferential ulcerated friable lesion at duodenum (D1-2) region and histopathology suggestive of moderately differentiated adenocarcinoma. Subsequent imaging studies revealed 6×5 cm duodenal mass in D1 and D2 without IHBRD with right ovarian mass. She underwent staging laparoscopy with open classic Whipple’s procedure with bilateral oophorectomy was done. Intraoperatively 6×6 cm mass involving first and second part of duodenum involving head of pancreas was found with 3×3 cm right ovarian mass. Post-operative period was uneventful and she discharged on POD6. Final biopsy was suggestive of moderately differentiated adenocarcinoma of duodenum with bilateral ovarian metastasis and she received adjuvant chemotherapy. Now at 1 year, on regular follow up she is completely asymptomatic and imaging showed no recurrent disease. Isolated ovarian metastasis may not be a contraindication for radical surgery in selected group of patients with duodenal carcinoma.
Overman MJ, Hu CY, Kopetz S, Abbruzzese JL, Wolff RA, Chang GJ. A population-based comparison of adenocarcinoma of the large and small intestine: insights into a rare disease. Ann Surg Oncol. 2012;19:1439-45.
Overman MJ, Hu CY, Wolff RA, Chang GJ. Prognostic value of lymph node evaluation in small bowel adenocarcinoma: analysis of the surveillance, epidemiology, and end results database. Cancer. 2010;116:5374-82.
Fenoglio-Preiser CM, Pascal RR, Perzin KH. Tumors of the intestines. In: Atlas of tumor pathology, 2nd series, fascicle 27. Washington, DC: Armed Forces Institute of Pathology. 1990: 175-250.
Delcore R, Thomas JH, Forster J, Hermreck AS. Improving resectability and survival in patients with primary duodenal carcinoma. Am J Surg. 1993;166(6):626-30.
Rose DM, Hochwald SN, Klimstra DS, Brennan MF. Primary duodenal adenocarcinoma: a ten-year experience with 79 patients. J Am Coll Surg. 1996;183(2):89-96.
Bruls J, Simons M, Overbeek LI, Bulten J, Massuger LF, Nagtegaal ID, et al. A national populationbased study provides insight in the origin of malignancies metastatic to the ovary. Virchows Arch. 2015;467:79-86.
Mitsushita J, Netsu S, Suzuki K, Nokubi M, Tanaka A. Metastatic Ovarian Tumors Originating From a Small Bowel Adenocarcinoma: A Case Report and Brief Literature Review. Int J Gynecological Pathol. 2017;36(3):253-60.
Loke TK, Lo SS, Chan CS. Case report: Krukenberg tumours arising from a primary duodenojejunal adenocarcinoma. Clin Radiol. 1997;52:154-5.
Henry JN, Tesfaye B, Dejenie F, Horton S, Layiemo A. Signet ring cell carcinoma of the duodenal bulb with metastases to the ovaries and the colon: a case report. J Med Cases. 2013;4(5):327-9.
Poultsides GA, Huang LC, Cameron JL, Tuli R, Lan L, Hruban RH, et al. Duodenal adenocarcinoma: clinicopathologic analysis and implications for treatment. Ann Surg Oncol. 2012;19:1928-35.