Cheng Joyce, Patel Ghanshyam, Khealani Milan, Korsapati Hariprasad, Reddy Shilpa, Vasavada Advait, Jain Shikha, Adak Shrestha, Regassa Henok
Mercyhealth Internal Medicine Residency, Javon Bea Hospital, Rockford, IL, US.
Marian University, Indianapolis, IN, US.
Maedica (Bucur). 2023 Jun;18(2):368-372. doi: 10.26574/maedica.2023.18.2.368.
Diagnosing small bowel cancer has been challenging due to its unusual presentation and inaccessibility on endoscopy. A 41-year-old male with a history of irritable bowel syndrome underwent esophagogastroduodenoscopy (EGD) for worsening fatigue and lightheadedness despite iron supplements therapy for low hemoglobin. Initial upper endoscopy showed esophagitis and non-bleeding duodenal bulb ulcer with exudate. Endoscopic ultrasound (EUS) with fine-needle aspiration was done due to persistent concern of malignancy and demonstrated moderately differentiated adenocarcinoma in the second portion of the duodenum. Endoscopic ultrasound with fine-needle aspiration may be a superior approach to diagnosing duodenal carcinoma than EGD alone. Small bowel cancer can be a part of the tumor spectrum of Lynch syndrome. Duodenal adenocarcinomas present at a late stage and portend a poor prognosis. We present a case of duodenal adenocarcinoma in an otherwise healthy individual emphasizing the importance of malignancy in the differential and genetic counseling in individuals with the family risk factor.
由于小肠癌的表现不寻常且在内镜检查中难以触及，其诊断一直具有挑战性。一名41岁男性，有肠易激综合征病史，尽管因血红蛋白低接受了铁补充剂治疗，但仍因疲劳加重和头晕而接受了食管胃十二指肠镜检查（EGD）。初次上消化道内镜检查显示食管炎和有渗出物的非出血性十二指肠球部溃疡。由于持续担心恶性肿瘤，进行了内镜超声（EUS）引导下细针穿刺活检，结果显示十二指肠第二部有中度分化腺癌。与单独使用EGD相比，内镜超声引导下细针穿刺活检可能是诊断十二指肠癌的更好方法。小肠癌可能是林奇综合征肿瘤谱的一部分。十二指肠腺癌多在晚期出现，预后较差。我们报告一例在其他方面健康的个体中发生的十二指肠腺癌病例，强调了在有家族风险因素的个体中鉴别诊断恶性肿瘤和进行遗传咨询的重要性。
