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A Rare Case of Duodenal Metastasis from Anaplastic Carcinoma of the Pancreas

Akira Yamamiya, Mimari Kanazawa, Keiichi Tominaga, Kenichi Goda, Shuhei Noda, Kazuyuki Ishida, Atsushi Irisawa

Anaplastic carcinoma not only infiltrates the surrounding tissue but also rarely metastasize to the gastrointestinal tract. Thus far, there are no reported cases of distant metastasis to the duodenum. Herein, we report a case of duodenal metastasis in a 65-year-old man. He had loss of appetite for a month, and his previous upper gastrointestinal endoscopy results revealed multiple sub-epithelial lesions with depression in the duodenum. Contrast-enhanced computed tomography then showed an intra-abdominal tumor with internal necrosis approximately 80 mm in size between the ventral segment of the pancreatic body, the lateral segment of the liver, and the lesser curvature of the stomach, multiple enlarged lymph nodes between the mediastinum and pelvic cavity, multiple intramuscular mass, and ascites. Biopsies taken from the duodenal lesion, intra-abdominal tumor, enlarged cervical lymph nodes, and immune-histology, revealed AE1/3 positive, maspin positive, CK7 negative, CK20 negative, and CA19-9 negative. We considered the possibility of a primary origin in the pancreas but failed to reach a definite diagnosis. We also considered chemotherapy for carcinoma of unknown primary origin, but the patient’s general health deteriorated rapidly, and he died on day 35 of admission. Pathological autopsy revealed that the intra-abdominal tumor contained a mixture of giant cells and spindle cells. Finally, we diagnosed the tumor as an anaplastic pancreatic carcinoma with rare duodenal metastasis.