Hammami Muhammad Bader, Chhaparia Anuj, Piao Jinhua, Zhou Yihua, Hachem Christine, Lai Jinping
Department of Internal Medicine, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Division of Gastroenterology and Hepatology, Saint Louis University School of Medicine, St. Louis, Missouri, USA.
Case Rep Gastroenterol. 2017 Jul 4;11(2):402-410. doi: 10.1159/000477715. eCollection 2017 May-Aug.
Despite being the largest part of the human gastrointestinal (GI) tract, the small intestine accounts for only 1-1.4% of all GI malignancies. Adenocarcinoma is the most common primary small bowel malignancy, with the most common site being the duodenum. On the other hand, squamous cell carcinoma (SCC) of the duodenum is extremely uncommon. We report the first case of mixed adenocarcinoma and SCC occurring in the third part of duodenum (D3). Our patient, a 64-year-old female with history of GERD, hypertension, and IDDM presented with 4 weeks of nausea, vomiting, and abdominal pain. Tomographic imaging of her abdomen demonstrated a distended stomach and a proximal duodenum with narrow caliber changes at the level of D3. An EGD revealed a tight stricture at D3 that could not be traversed. Stricture biopsies revealed duodenal mucosa with two small foci of SCC (positive for p63 and CK5/6) and adenocarcinoma (positive for CK7 and Moc31). Peritoneal metastases were detected on exploratory laparotomy, making the tumor surgically incurable. As she progressively declined and with worsening liver enzymes and general debility, she was not a candidate for chemotherapy and was eventually discharged on home hospice. Small bowel SCC/adenocarcinoma is an exceedingly uncommon cancer, making further case reports such as ours important to understand the nature of this entity and establish management guidelines.
尽管小肠是人体胃肠道（GI）的最大组成部分，但小肠恶性肿瘤仅占所有胃肠道恶性肿瘤的1-1.4%。腺癌是最常见的原发性小肠恶性肿瘤，最常见的部位是十二指肠。另一方面，十二指肠鳞状细胞癌（SCC）极为罕见。我们报告了首例发生在十二指肠第三部分（D3）的混合性腺癌和SCC病例。我们的患者是一名64岁女性，有胃食管反流病、高血压和胰岛素依赖型糖尿病病史，出现了4周的恶心、呕吐和腹痛症状。她腹部的断层扫描成像显示胃扩张，十二指肠近端在D3水平有管径变窄的变化。上消化道内镜检查显示D3处有一个紧密狭窄，无法通过。狭窄部位活检显示十二指肠黏膜有两个小灶性SCC（p63和CK5/6阳性）和腺癌（CK7和Moc31阳性）。在剖腹探查中发现了腹膜转移，使得肿瘤无法通过手术治愈。由于她的病情逐渐恶化，肝功能酶指标恶化，全身虚弱，她不适合进行化疗，最终出院接受家庭临终关怀。小肠SCC/腺癌是一种极其罕见的癌症，因此像我们这样的进一步病例报告对于了解该实体的性质和制定管理指南很重要。
