Devadass Clement Wilfred, Okaly Geetha V Patil, Hm Sudha, Pai Sreekar Agumbe, Sridher H
Associate Professor, Department of Pathology, M.S., Ramaiah Medical College and Teaching Hospital , Bangalore, India .
Assistant Professor, Department of Pathology, M.S. Ramaiah Medical College and Teaching Hospital , Bangalore, India .
J Clin Diagn Res. 2014 Aug;8(8):FD01-2. doi: 10.7860/JCDR/2014/9474.4693. Epub 2014 Aug 20.
Duodenal adenocarcinoma (DACa) is a rare malignancy, the presenting symptoms of which are vague and nonspecific. We report the case of a patient presenting with symptoms of subacute small bowel obstruction whose CT scan revealed i) left adnexal mass and ii) compression of 3(rd) portion of duodenum with reduced aortomesentric angle consistent with Wilkie's syndrome (WS). Laparatomy in addition revealed a distal duodenal stricture, which showed a well differentiated DACa causing subtotal intestinal obstruction. The ovarian mass revealed adenocarcinoma with similar morphology. Immunophenotypic analysis revealed positive expression of CK 20 and CDX 2 and absence of CK 7 staining in the tumours consistent with Primary DACa with ovarian metastasis. We further concluded that the WS resulted from reduced mesenteric fat pad caused by DACa induced cachexia. The case highlights the elusive nature of duodenal malignancy and emphasises the importance of meticulous small bowel examination during exploration of ovarian masses.
十二指肠腺癌（DACa）是一种罕见的恶性肿瘤，其临床表现模糊且不具特异性。我们报告了一例表现为亚急性小肠梗阻症状的患者，其CT扫描显示：i）左侧附件肿块；ii）十二指肠第三段受压，腹主动脉肠系膜角减小，符合威尔基综合征（WS）。剖腹手术还发现十二指肠远端狭窄，病理显示为高分化DACa，导致小肠不全梗阻。卵巢肿块显示为形态相似的腺癌。免疫表型分析显示肿瘤中细胞角蛋白20（CK 20）和尾型同源盒转录因子2（CDX 2）呈阳性表达，细胞角蛋白7（CK 7）染色阴性，符合原发性DACa伴卵巢转移。我们进一步得出结论，WS是由DACa引起的恶病质导致肠系膜脂肪垫减少所致。该病例突出了十二指肠恶性肿瘤难以捉摸的特性，并强调了在探查卵巢肿块时仔细检查小肠的重要性。
